Publisher Health

A new guideline for reporting research results has been developed to improve reproducibility, replication, and transparency in life sciences.
The new Research Materials, Design, Analysis and Reporting (MDAR) Framework will harmonise the recording of outcomes across several major journals, its developers say.
Existing guidelines address specific parts of biomedical research, such as ARRIVE — which relates to animal research — and CONSORT, associated with clinical trial reporting.
The MDAR Framework — developed by a team from the University of Edinburgh, the Centre for Open Science and six major journal publishers — complements these by establishing basic minimum reporting requirements and best practice recommendations.
The Framework is outlined in a new publication in the Proceedings of National Academy of Sciences.
Experimentation with various guidelines has resulted in a fragmented landscape, which, even though it has improved reporting, has increased the burden on authors’ and editors’ time.

A Lancaster University professor has introduced a new concept for rapidly analysing for the presence of a virus from colds to coronaviruses.
Based on analysing chemical elements the methodology, which has been adapted from an analytical technique used to identify metallic nanoparticles, is able to detect the presence of viruses within just 20 seconds.
Although the tests would need to be performed in a lab, it could be used to quickly identify whether people admitted to hospitals have been infected by a virus — enabling clinicians to decide treatments and also whether to admit patients into isolation wards.
The proposed technique, called ‘Single virus inductively coupled plasma mass spectroscopy’ (SV ICP-MS) analysis, can be used to quickly determine families of viruses. However, although the concept can identify that someone has a type of coronavirus for example, it would not be able to determine the type of coronavirus, or variants. Additional tests would still be required to find out the specific virus someone was infected with.
While SV ICP-MS is not an alternative for tests developed to specifically identify types of Covid-2 infections, it could be used to discriminate if viruses from one family, such as coronaviruses, are present or not. If a virus is found to be present, more specific testing would be needed.
The concept, developed by Professor Claude Degueldre, from Lancaster University’s Department of Engineering, uses diluted samples of fluids, such as nasal mucus or saliva, from patients. A plasma torch is used to atomise and ionise the virus particles. Measurements of intensities for selected masses of the elements from the viruses provide rapid results to show the presence of a virus or not. This process works on DNA and RNA virus types within seconds.
Complementary analysis such as existing sequencing techniques can be tested to complete the identification, though they can take up to two days.
Another key benefit is the ability to test a large number of samples quickly.
Professor Degueldre said: “What we are proposing here is not a new Covid test but is a new concept to rapidly find out if there are viruses present. This would be useful if people are ill but it is not known if they have a virus or another health condition that is making them sick. This concept would inform the clinical team whether or not there is a virus to inform early treatment actions and other measures such as the need for isolation. More detailed tests would still be required to discover the exact viral infection, but results from these take longer.
“Another application for the concept is to test water samples from sewage systems or down flow in rivers. The results would enable public health experts to identify areas of cities that have viral outbreaks.”
The concept is still at an early stage and further research and experiments are needed to further develop the process.
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Materials provided by Lancaster University. Note: Content may be edited for style and length.

Brain changes in people with Alzheimer’s disease and in those with mild traumatic brain injuries (TBIs) have significant similarities, a new USC study shows, suggesting new ways to identify patients at high risk for Alzheimer’s. The findings appear this week in GeroScience.
TBIs, which affect over 1.7 million Americans every year, are often followed by changes in brain structure and function and by cognitive problems such as memory deficits, impaired social function and difficulty with decision-making. Although mild TBI — also known as concussion — is a known risk factor for Alzheimer’s disease, prior studies haven’t quantified the extent to which these conditions share patterns of neural degeneration in the brain.
USC researchers hypothesized that comparing these patterns could reveal not only how the degenerative trajectories of the two conditions are similar but also which features of brain atrophy could predict Alzheimer’s risk after TBI.
The study included 33 study participants with TBIs due to a fall, another 66 participants who had been diagnosed with Alzheimer’s disease and 81 healthy control participants without either TBI or Alzheimer’s. The researchers analyzed MRIs of the patients’ brains and created additional computer-generated models to compare dozens of different brain structures, ultimately mapping similarities and differences between the three different groups.
In multiple brain areas of both TBI and Alzheimer’s participants, the researchers found reduced cortical thickness when compared to the healthy controls. Cortical thickness is roughly correlated with brain age and its thinning is often associated with reductions in attention, memory and verbal fluency, as well as with decreased ability to make decisions, integrate new information and adapt one’s behavior to new situations, among other deficits.
“These findings are the first to suggest that cognitive impairment following a traumatic brain injury is useful for predicting the magnitude of Alzheimer’s-like brain degradation,” said study author Andrei Irimia, an assistant professor of gerontology, neuroscience and biomedical engineering at the USC Leonard Davis School of Gerontology and the USC Viterbi School of Engineering. “The results may help health professionals to identify TBI victims who are at greater risk for Alzheimer’s disease.”
Using MRIs, the study identified significant similarities between TBI and Alzheimer’s disease in how the brain’s gray and white matter degrade after injury. In gray matter — the part of the brain that contains neuron cell bodies and their short-range connections — the most extensive similarities were in areas involved in memory (temporal lobes) and decision-making (orbitofrontal cortices).

The pharmaceutical giant says the legal action is “without merit” and vows to defend itself.

A variety of digital and old-fashioned approaches are being used around the globe to confirm Covid-19 vaccination. But the world is still far from a universal standard of proof.It is the latest status symbol. Flash it at the people, and you can get access to concerts, sports arenas or long-forbidden restaurant tables. Some day, it may even help you cross a border without having to quarantine.The new platinum card of the Covid age is the vaccine certificate. It is a document that has existed for more than two centuries, but it has rarely promised to hold so much power over culture and commerce. Many versions of these certificates now come with a digital twist.“It’s been a long time since we’ve had a pandemic that has impacted every facet of society so thoroughly, and then a vaccine,” said Carmel Shachar, the executive director of the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School. “There is no precedent since 1918, and we definitely didn’t have smartphones in 1918.”Ramesh Raskar, a professor at M.I.T. Media Lab, has been leading an effort to develop a solution that includes both a paper certificate that anyone can easily carry as well as a free digital pass that works even without cell service.We are going to emerge from the pandemic with a new “currency for health,” he said.Figuring out how these passes should be used and what they should look like is dividing lawmakers, business leaders, ethicists, designers and health officials.Paper certificates from Shanghai, São Paulo and Uttar Pradesh, India. Anil Kumar Shukla and Ernesto Londoño/The New York Times An Easy Pass Made of Flimsy PaperA Covid-19 vaccination card does not always convey the significance of the document. Nor are the cards typically designed to counter fraud. Most of the hundreds of millions of people worldwide who got at least one shot of a Covid-19 vaccine in the past few months received a flimsy piece of paper.Unlike the easily recognizable “yellow card” that international travelers have long used to document other kinds of immunizations, the designs for Covid-19 vaccination certificates vary from state to state and country to country. In São Paulo, the cards have a green border. In Shanghai, they are stamped in red. In parts of Mexico and Lebanon, they are the size of passports, with the handwriting of the person who filled it out.In India, the certificate is a fully typed printed page. Next to the pronouncement that reads “Together, India will defeat Covid-19” is a photo of the country’s prime minister, Narendra Modi, a rare flourish.In some parts of the world, vaccine proof has gotten people a range of goods: free popcorn and ice cream, and even discounted beers. But for the most part, they have just allowed people to post selfies or to reassure their acquaintance. Some governments are looking for more formal systems that work on phones and counter fraud. Here is a look at some early efforts.DenmarkA template of Denmark’s vaccine passport.Denmark Ministry of HealthName: Coronapas (Corona Passport)Could it get you an indoor table? Yes. In Denmark, restaurants have been open for just takeout since December and have reopened this month with the caveat that only those with a Coronapas can sit indoors, the ministry of health said.How about a concert or sports game? That, too. As part of the country’s reopening plans, the government sanctioned indoor seating for sports and other stadium events for pass holders.Anything else? On April 6, hair salons, tattoo businesses, massage parlors and driving schools opened exclusively to customers with Coronapas. The Danish government does not track each time the pass is used, the ministry said, but about 3.5 million people had visited the app or site in its first week. The app is also intended to be a way for travelers to show other countries that they have been vaccinated.How do you get one? You have to be fully vaccinated and have tested negative for the coronavirus within the past 72 hours or overcame an infection within the past 180 days. Danish citizens can download the app on their smartphone or visit a website to print the Coronapas, which exudes the somber vibe of an old-school train ticket.Isn’t the European Union also developing a system? Yes. On June 21, the E.U. is expected to introduce a certificate called a Digital Green Pass, with the aim of allowing people who have been vaccinated against the coronavirus to travel more freely. Under the proposed rules, each nation within the bloc could decide which travel restrictions, such as obligatory quarantine, to waive for Digital Green holders. But many countries, including Denmark, say they cannot afford to wait for the Digital Green Pass and are developing their own versions.IsraelIsrael’s Green Pass app features a gif of a family headed on a trip.Name of card: The Green PassCould it get you an indoor table? Yes.How about entry to a concert or sports game? That, too.Anything else? The pass allows you to enter many businesses, including swimming pools, gyms, theaters and wedding halls, as well as cultural events, such as concerts, sports games and religious gatherings. Having the pass may also mean that you may not have to quarantine for 10 to 14 days after international travel.How does it work? In late February, Israel’s ministry of health began offering the Green Pass to fully vaccinated residents and individuals who have recovered from Covid-19. When booking a table at a restaurant, many of the businesses began to ask, “Do you have a Green Pass?” Israelis can print their certificates containing a QR code, download the code onto their phones or flash the app itself.What’s with that family? The app and other Green Pass materials feature an animated illustration of a family of three. The man is wearing shorts, a backpack and a camera around his neck, suggesting he’s on vacation. His son and wife are wearing masks, but their postures are relaxed as they pull their suitcases.Aparna Nair, a professor of science history at the University of Oklahoma who maintains a collection of vaccination certificates going back to the 1820s, said that this detail was noteworthy: “They are using the design of the vaccine passport to form visual connections with life after the pandemic, essentially, the vaccine as a literal passport to the rest of the world.”Are there concerns about requiring it so widely? Absolutely. Seema Mohapatra, a law professor specializing in health care and bioethics, noted that many people in the West Bank and Gaza strip had not been vaccinated, raising equity concerns.EstoniaA template of Estonia’s vaccine app.GuardtimeName of card: VaccineGuardCould it get you an indoor table? Not yet.How about entry to a concert or sports game? Not that either. Some business owners and cultural event organizers have expressed the hope that the Estonian government will waive capacity limitations and other restrictions if they agree to check for the certificate at the door, said Dr. Ain Aaviksoo, the chief medical officer at Guardtime, the company that worked with the Estonian government and the W.H.O. to design the certificate. But this hasn’t happened yet.So what is it good for? As of April 30, it will be most useful for going to and from Finland and back on the ferry.Is that really such a high-demand journey? Yes. About 10 percent of the Estonian working population is employed in Finland, Dr. Aaviksoo said. For years, it has been common for Estonians to stay in Helsinki during the week and then take the two-hour ferry ride home to Tallinn for the weekend. That has not been possible during the pandemic. Finland also fuels Estonia’s summer tourism.How does it work? Estonia says it cannot afford to wait for the E.U.’s Digital Green Pass. Starting April 30, residents can download a vaccination certificate, containing a QR code.New YorkA template of New York State’s Excelsior Pass which shows proof of vaccineNew York StateName: Excelsior PassCould it get you an indoor table? Yes.How about entry to a concert or sports game? That, too.Anything else? The state has been requiring some government employees to use it. It’s up to businesses and private organizations to decide whether they want to require the pass for entry. So far, the system has been used at restaurants, weddings, Madison Square Garden, Barclays Center and Yankee Stadium, according to Eric Piscini, vice president of Emerging Business Networks at IBM Watson Health, which designed it.How does it work? New York began offering downloads of the app in March. It verifies whether someone is fully vaccinated or has recently tested negative. Around 400,000 people throughout the state have downloaded it so far, Mr. Piscini said. The pass generates a QR code that can be scanned to produce a green checkmark or a red X. Those without compatible phones can print out their codes, he said.Who scans green? A person could obtain green not only by being fully vaccinated more than 14 days ago, but also by getting a negative PCR test within three days or a negative antigen test — often referred to as a rapid Covid test — within the past six hours. One challenge: only people vaccinated or tested in New York State can use it. “If you live in New Jersey, you will have to get tested in New York to get added to the database and go to the stadium,” Mr. Piscini said. IBM is trying to figure out how to access data from other states. Some venues may also accept other forms of certification.Will there ever be a national app for the U.S.? No. All of the 138 million Americans who have completed their first shot should have received the same Covid-19 vaccine record card created by the Centers for Disease Control and Prevention. But it’s up to states, universities and businesses to decide whether they want to require these cards or offer a supplemental app. The White House said in March there were no plans for a universal federal vaccination database or a mandate for a single credential. While New York has promoted Excelsior as the way to safely and quickly reopen the state, lawmakers in at least a half-dozen states, including Texas, Florida and Arkansas, have moved to ban businesses from requiring vaccination, saying it is a privacy violation or will slow down reopening of commerce.What differentiates Excelsior visually? It is the only Covid-19 vaccine pass to produce a large illustration of the Statue of Liberty when it is scanned.Isabel Kershner contributed reporting from Jerusalem, Suhasini Raj from New Delhi and Ernesto Londoño from Rio de Janeiro

Many think the abdominal disorder starts in childhood, but it can occur at any age and is becoming more prevalent throughout the world.Shelley Martin, a Manhattan accountant, was in her mid-60s when she learned after a routine colonoscopy that she had Crohn’s disease, a chronic inflammatory disorder characterized by abdominal pain and diarrhea. She said when friends learned of her diagnosis, several said “How can that be? Crohn’s starts in childhood.”Actually, this often debilitating disease, which typically affects the area where the small intestine joins the colon, can occur at any age. “If you’re born with the right genetics, it can first appear in young kids to people in their 80s or 90s,” said Dr. Joseph D. Feuerstein, gastroenterologist at Beth Israel Deaconess Medical Center in Boston. “It’s rising in incidence and prevalence throughout the world,” he said, and gastroenterologists are still trying to figure out why it shows up when it does in different people.Crohn’s disease was first described in 1932 by Dr. Burrill B. Crohn and colleagues and is one of two chronic inflammatory bowel diseases (ulcerative colitis is the other) that have no specific cause. Together, they afflict about three million people in the United States. Crohn’s in adults starts on average at age 30, with peak incidence between ages 20 and 30 and a second peak around age 50. The disease tends to run in families, but the genetic risk is not large. One in 10 to one in four patients have a close family member who is affected, and only half of identical twin pairs get it.In decades past, Crohn’s was thought to primarily afflict people of Ashkenazi Jewish descent, but “we’re now seeing it everywhere — in Asia, Latin America, all over the world,” said Dr. Feuerstein.Experts speculate that its rise is somehow linked to industrialization and a Western-style diet rich in meats and processed foods. Some suggest a link to living in an overly hygienic environment that may prompt the immune system to attack the body’s healthy tissues instead of infectious organisms.And even though the bowel is the disease’s most prominent target, “it can also involve the eyes, joints, liver, skin,” said Dr. Gary R. Lichtenstein, gastroenterologist at the University of Pennsylvania School of Medicine. “It’s not one distinct disorder — over 200 genes have been identified as associated with Crohn’s. It results from a complex interaction between the environment and genetics” and can be initiated by an individual’s response to exposures ranging from infectious agents to medications.Two well-established instigators are the frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, and cigarette smoking. Both can trigger onset of the disease or cause flare-ups in those who already have it, Dr. Lichtenstein said. In fact, he said, smoking not only creates a greater risk of developing Crohn’s, it can also result in a more virulent course of the disease.Unlike Ms. Martin, who had no inkling anything was wrong until her routine colon exam, most people with Crohn’s have unexplained symptoms for many months or even years before the correct cause is determined. Following the diagnosis, she said she developed “mild but annoying diarrhea,” but she considers herself relatively lucky given the potential complex of symptoms associated with Crohn’s.In addition to abdominal pain and diarrhea that can be bloody, possible signs and symptoms include unexplained weight loss, anemia, fever, fatigue, nausea and vomiting, loss of appetite, eye and joint pain and tender, red bumps on the skin. In children, the disease can result in a failure to grow.Prompt diagnosis and appropriate therapy to suppress inflammation in the digestive tract are extremely important because a delay can result in scar tissue and strictures that are not reversed by medication, Dr. Feuerstein said. Another possible serious complication is development of a fistula — an abnormal connection between different organs, like the colon and bladder, requiring surgical repair that, in turn, can cause further intestinal damage.Understandably, considerable stress, anxiety and depression can accompany the disease and may even cause a worsening of symptoms. Last summer, when Ms. Martin’s disease suddenly raged out of control after she was treated with a drug to keep breast cancer at bay, severe diarrhea kept her tied to the bathroom in her Manhattan apartment. Dr. Lichtenstein said the class of drugs Ms. Martin took, called checkpoint inhibitors, is especially challenging to Crohn’s patients who may have to choose between trying to prevent a recurrence of cancer and suppressing their intestinal disease because the cancer drugs can sometimes cause an inflamed colon.If severe inflammation and debilitating symptoms are present when Crohn’s is diagnosed, patients are usually treated with steroids to bring the disease under control before they are placed on medication specific for the condition. “Steroids,” Dr. Feuerstein said, “are a Band-Aid to arrest the inflammatory process, but then we have to do something to suppress the disease and allow the body to heal.”Sometimes before starting medication, patients are temporarily placed on a restricted liquid diet to rest the bowel and give it a chance to heal, said Dr. Lichtenstein, the lead author of the latest management guidelines for Crohn’s disease developed by the American College of Gastroenterology.There are now multiple drug options for treating Crohn’s, although keeping symptoms under control often involves trial and error. For example, following Ms. Martin’s diagnosis five years ago, the specialist she consulted told her there were four possible oral drugs to try in succession. Each worked for several months, but after the fourth drug no longer relieved her symptoms, she was given an infusion of a remedy called Entyvio, which she said “worked immediately like a miracle.”Entyvio, the trade name for vedolizumab, is what’s known as a biologic, a drug made from living cells that is typically given by infusion or injection, one of several such drugs now available for Crohn’s. It acts specifically on the gut to counter inflammation, and with her colon still inflamed, Ms. Martinneeds to be treated with the drug every four weeks. If this one stops working, she can try one of the others.Ms. Martin knows, however, that Crohn’s is not curable and most patients have to stay on medication indefinitely. That can create yet another stumbling block. The biologics are very costly, averaging over $100,000 a year, and although they are usually covered by insurance, there is a steep co-payment. To afford the therapy, many patients depend on co-pay assistance programs administered by the drug companies, Dr. Feuerstein said.However, as Ms. Martin recently learned, Medicare will cover the expense if she gets the infusion in a hospital or if her doctor can arrange for a nurse to come to her home to administer the drug.

Sesame becomes a “major allergen,” joining milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans.If you have a food allergy, or your child does, chances are you spend a lot of time reading labels to figure out whether something will trigger an allergic reaction.If you’re allergic to sesame, it’s more complicated. While federal law since 2004 has required companies to warn people when certain allergens are used to make a product, sesame has not been one of them. That has meant someone with an allergy to sesame couldn’t know for sure whether the foods they bought at the store were safe.That is changing. On Friday, President Biden signed into law the FASTER Act, which adds sesame to the list of foods that manufacturers must identify on prepackaged labels. Here are some key takeaways.Sesame becomes the ninth food to be considered a “major allergen.”The other eight foods — milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans — were part of legislation that was signed into law in 2004. That law required manufacturers to indicate on labels when a product was made using any of those eight ingredients, describing them as “major food allergens” because they collectively accounted for “90 percent of food allergies.”If something is made using any of those eight products, you can be certain to find it on the label, either within the ingredients list or nearby with a special “contains” warning — “contains wheat,” for example.The legislation was a breakthrough for people with food allergies. The right words on a label can be the difference between an uneventful lunch and an allergic reaction — including an anaphylactic one, which can be fatal.But because sesame wasn’t part of the initial law 17 years ago, companies were not required to include it, making it hard to know for sure whether packaged food contains sesame. According to the Food and Drug Administration, in some cases, sesame is described on the label as “spices” or “natural flavors.”In the years since the 2004 law was passed, studies have found that sesame allergy is more common than was previously known in the United States. Although it’s much less prevalent than peanut allergy, it is comparable with certain tree nut allergies. Tree nuts were on the original list of major allergens.Now that the FASTER Act is the law, sesame will need to be included on labels, just like the other eight allergens.The ingredient must be listed on labels starting in 2023.It may be a while before you see the effects of the FASTER Act. The law gives manufacturers 20 months to make sure any products they’re making that include sesame reflect that on packaging.Starting on January 1, 2023, if food contains sesame, you should see it indicated on the label.In the meantime, if you or someone in your family is allergic, look for ingredients that could be sesame-based, like tahini, sesamol and gomasio, according to Food Allergy Research & Education, a nonprofit organization in McLean, Va. And continue to keep an eye out for “spices” and “natural flavors,” which could include sesame.It also helps to be aware of the types of foods that tend to include sesame, like falafel, hummus and certain rices. And sesame oil is a common ingredient in Asian cuisine. But keep in mind that sesame can also be found in chips, cereals, snack bars and a variety of other foods.The good news is that some companies, such as General Mills and Hershey’s, already include sesame on labels when it’s used as an ingredient.It’s welcome news for over a million Americans.The new law brings a sense of reassurance to people dealing with a sesame allergy. In the United States, that’s about 1.1 million children and adults, according to a 2019 study published in the journal JAMA Network Open. The study found that less than one quarter of 1 percent of children and adults were estimated to have sesame allergy.Still, Lauren E. Krigbaum is among the parents who is breathing a sigh of relief. Ms. Krigbaum’s 2-year-old daughter has five different food allergies, including sesame. But until now, sesame had been the only one of her daughter’s allergies that wasn’t part of the federal labeling law.“When you have a child with food allergies, your life kind of centers around food,” said Ms. Krigbaum, a financial aid counselor in Boise, Idaho. “So being able to take a stress out of that is going to be huge.”The law will also make grocery shopping easier for adults. The 2019 study, as well as previous studies in 2007 and 2008, found that most children don’t outgrow a sesame allergy. And like other allergies, you can develop it as an adult — about one in four adults who suffer from it developed it after childhood.The inbox of Lisa G. Gable has been “overwhelmed” with messages of relief. Ms. Gable is the chief executive of FARE, which has been pushing for sesame to be added to the list of allergens.“It was critically important to get this on the label and we’re excited to have it advancing so quickly with bipartisan support,” said Ms. Gable.Other allergens still remain off the government’s list.The new allergen law extends the federal government’s list of “major allergens” to nine foods. But other less common allergens can still go into foods without being printed on packaging.Other countries have longer lists of allergens required for labeling. Canada has a list of 11 foods, including mustard, required for packaging. Australia’s list comprises 10 foods, one of which is lupin, a type of legume. And the United Kingdom mandates that 14 allergens be declared on labels.When Nili M. Patel, of Raleigh, N.C., heard about the FASTER Act, she was relieved.“It was like, finally!” said Ms. Patel, whose 4-year-old daughter has multiple food allergies, including sesame. “The most frustrating allergen for me is sesame because it’s hidden.”Sesame allergies often appear alongside other food allergies, like peanut, tree nut and egg. Ms. Patel’s daughter is also allergic to certain types of legumes that aren’t part of the labeling law. She said she makes “99 percent” of meals from scratch, including bread, and will continue doing that out of caution.“I hope that maybe eventually other allergens will make their way into the labeling laws,” said Ms. Patel. “Maybe there’s some hope for that.”But the law opens the door for future food allergy research and policy.In addition to the sesame requirement, the new law also has broad implications for food allergies. It says that the Secretary of Health and Human Services must compile a wide-ranging report on food allergies within the next 18 months.The report should document any work the federal government does related to a spectrum of food allergy issues, including research into the prevalence of food allergies, treatment options and possible prevention methods.It also calls for “a regulatory process and framework” to determine a food as a “major food allergen,” which could open the door for other allergens to be added to the list.Dr. Ruchi S. Gupta, a professor of pediatrics at Northwestern Medicine in Chicago, said these sections of the FASTER Act put food allergies on a similar level with other health conditions because it centralizes efforts to monitor food allergies.“We need to do a deeper dive into what is 10, 11, 12” on the list of top allergens, said Dr. Gupta, a senior author of the 2019 study. “And what is potentially on the horizon to be a bigger problem than it is now.”

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesThe Australian city of Perth will end a snap three-day lockdown that began after a man contracted Covid in hotel quarantine and moved around the community while infectious.Three local cases have been reported since Friday, and restrictions are set to be lifted at midnight (GMT 17:00).State Premier Mark McGowan said the harsh steps had been “necessary”.Australia’s snap lockdowns have helped contained Covid outbreaks and kept infection rates low.Mr McGowan described the lockdown in the West Australian capital as a circuit-breaker that had “done the job it was designed to do”.About two million residents in Perth, and the nearby Peel region, have been subject to stay at home orders since Friday. Schools and most businesses are set to reopen, though some restrictions – including mandatory mask wearing – will remain. “We need to be cautious as we come out of lockdown as the virus could still be out there,” he said.Western Australia will also temporarily reduce the number of international arrivals. Last week, Australia said it would temporarily cut the number of incoming flights from India by 30% as the country deals with a devastating surge in Covid cases.In Australia, snap lockdowns have proved to be an effective health measure to help suppress Covid outbreaks early on. The country has fared much better than most other nations during the pandemic, with fewer than 30,000 cases and 910 deaths. At the same time, frustration has grown in Australia over the slow pace of the vaccination rollout. The immunisation programme has been beset by delays and the country has one of the world’s lowest Covid vaccination rates. What’s gone wrong with Australia’s vaccine rollout?Quarantine concerns Despite its success in managing outbreaks, the latest Australian lockdown again ignited debate over the safety of the country’s hotel quarantine system. The case at the centre of the Perth lockdown was a returned traveller who probably became infected in hotel quarantine. He spent five days in the community before testing positive, along with one of his close contacts, which marked the first case of community transmission of the virus in Western Australia in 12 months. Australia has imposed strict border controls and all international arrivals – essentially restricted to returning residents or travellers from New Zealand – must complete two weeks mandatory hotel quarantine at their own expense.While hundreds of thousands of people have gone through the system, several small outbreaks have been tied to hotel quarantine. The virus has spread from infected people in one room to those in neighbouring rooms. Critics have argued that quarantining in populated city centres amplifies the risk of spread.The Australian Medical Association (AMA) has been among those calling for an overhaul of the hotel system due to problems with infection control and airborne spread inside the facilities.”The hotels have never been fit for purpose and we’ve been saying that from the start,” Dr Andrew Miller, AMA Western Australia president, told Australian Broadcasting Corporation on Monday. Western Australia’s premier Mr McGowan, among others, has called on the federal government to set up dedicated quarantine facilities and divert travellers away from hotels. He suggested immigration detention centres or air force bases could be used as an alternative.But the federal government has argued such sites aren’t fit for the job – given a lack of segregation within those facilities for eating and washing – and that the states are better placed to manage quarantine.

SharecloseShare pageCopy linkAbout sharingMost hospitals in Delhi and many other cities in India have completely run out of beds, forcing people to find ways to get treatment for sick patients at home. But even that is proving to be a difficult task as prices of oxygen cylinders, concentrators and essential medicines have skyrocketed on the black market. Anshu Priya spent most of her Sunday looking for an oxygen cylinder as her father-in-law’s condition continued to deteriorate. She couldn’t find any hospital bed in Delhi or in its suburb of Noida. Her search for an oxygen cylinder in shops was also futile, forcing her to turn to the black market.She paid the hefty amount of 50,000 rupees ($670; £480) to procure a cylinder from the black market. It costs 6,000 rupees in normal times. Her mother-in-law is also struggling to breathe and Anshu is now worried about her. She says she may not be able to afford another cylinder on the black market.Countries send urgent aid to Covid-stricken IndiaPatients die without oxygen amid Delhi Covid surgeWhy India is running out of oxygen againHow have you been affected by coronavirus in India? Email: haveyoursay@bbc.co.uk.The BBC also called several oxygen cylinder suppliers and most of them asked for at least 10 times more than the normal price. Her struggle is not unique. Hospitals in many cities, including Delhi, Noida, Lucknow, Allahabad and Indore, have run out of beds, leaving families to rely on makeshift arrangements at home. The situation is particularly dire in Delhi where there are no ICU beds left. Families, those who can afford it, are hiring nurses and remote consulting a doctor to keep their loved ones breathing. India has been reporting more than 300,000 cases for days, setting new daily global records. On Monday, it had the highest number of daily coronavirus cases for a fifth straight day, reporting 352,991 new infections and another 2,812 deaths in the previous 24-hour period.This sharp spike has overwhelmed the healthcare system of many cities, and left no choice for families but to arrange whatever they can at home for their sick loved ones. But the struggles are huge from getting blood tests done to getting a CT scan or x-ray.Labs are overrun and it’s taking up to three days for test results to come back. This is making it harder for treating doctors to assess the progression of the disease. CT scans are also used by doctors to asses the condition of the patient but it’s taking days to get an appointment.Doctors say that these delays are putting many patients at risk. RT-PCR tests are also taking days. I know several sick patients who found a bed but couldn’t get admitted as they didn’t have a positive Covid report. Back to getting treatment at home, Anuj Tiwari hired a nurse to assist in the treatment of his brother at home after he was refused admission in many hospitals. image copyrightGetty ImagesSome said they didn’t have any free beds and others said they were not taking new patients due to continuing uncertainty over the supply of oxygen. A number of patients have died in Delhi due to a lack of oxygen supply. The city’s hospitals are desperate and some have been issuing daily warnings, saying they are left with just a few hours of oxygen. Then the government swings into action and tankers are sent, which is often enough to run the hospital for a day.A doctor in Delhi said that was how hospitals were working and “there are real fears now that a big tragedy may happen”. Given the scenario at hospitals, Mr Tiwari paid a hefty amount to procure a concentrator – which can extract oxygen from the air – keep his brother breathing. The doctor also asked him to arrange the anti-viral drug remdesivir, which has been given emergency-use approval in India and is being prescribed widely by doctors. The benefits of the drug – which was originally developed to treat Ebola – are still being debated across the world. Mr Tiwari couldn’t find the drug in any medicine shop and eventually turned to the black market. His brother’s condition continues to be critical and the treating doctor says he may soon need a hospital where remdesvir could be administered. “There are no beds. What will I do? I can’t even take him anywhere else as I have already spent so much money and don’t have much left,” he said.He added that “the desperate battle to save Covid patients has shifted from hospitals to home”, and even that is proving to be a daunting task as “we don’t have easy access to oxygen”. Remdesivir is in such short supply that families of the patients who are being treated at home are rushing to procure it. They want to have the drug in case the patient is required to go to hospital and may need the drug.The BBC spoke to several dealers on the black market who said the supply was tight and that was why they were charging such high prices. The government has allowed seven firms to manufacture remdesvir in India and they have been told to ramp up production. But several promises of adequate supply from the government have failed to show any result on the ground. Epidemiologist Dr Lalit Kant says the decision to ramp up production was taken too late and the government should have been prepared for the second wave. “But somehow the drug is available in the black market, so there is some leakage in the supply system which the regulators haven’t been able to plug,” he says.”We learnt nothing from the first wave.”image copyrightGetty ImagesAnother drug that is in huge demand is tocilizumab. It is normally used to treat arthritis but studies have shown that it can reduce the chances of a very sick patient needing to go on a ventilator. Doctors are prescribing the drug mostly to patients who are severely sick. But it has disappeared from the market. Cipla, the Indian company that imports and sells the drug, has been struggling to meet the rising demand.It usually costs around 32,480 rupees for a vial of 400mg. But Kamal Kumar paid 250,000 rupees to buy one dose for his father. He said the price was “mind boggling” but he had no other option but to pay.But not many in India can afford to pay the price and they are being exploited in their desperation to save their loved ones. Public health expert Anant Bhan says the government should have procured the drug in huge quantities. “Not many can afford to pay the official price of the drug, forget about the black market prices. This shows that there was no planning. The government failed to anticipate the wave and plan for it,” he says.”People have been left to their own fate.”CheatingFake remdesivir has also appeared in the black market. When the BBC questioned a dealer that the drug he was offering seemed fake as the firm manufacturing it wasn’t on the list of the companies licensed to produce it in India, he replied that it was “100% original”.The packaging was also full of spelling errors. But he shrugged and asked me to get it tested in any laboratory. The firm also has no presence on the internet.image copyrightGetty ImagesBut such is the desperation that people are willing to buy even questionable drugs. And some have been cheated as well. People are constantly sharing phone numbers of suppliers who can provide anything from oxygen to medicines. But not all of these numbers are verified.An IT worker, who did not want to be named, said that he desperately needed to buy an oxygen cylinder and remdesivir, and he got a lead from Twitter. When he contacted the person, he was told to deposit 10,000 rupees as advance payment.”The moment I sent the money, the person blocked my number,” he said.Desperation is driving people to trust anything in the hour of need and that seems to be fuelling the black market. Several state governments have promised to crack down on black marketing of remdesivir and some arrests have also been made. But the black market seems unfazed.Mr Tiwari says people like him don’t have any choice but to pay more.”It seems you can’t get treated in hospitals, and now you can’t save your loved ones even at home.”How have you been affected by coronavirus in India? Tell us your story by emailing: haveyoursay@bbc.co.uk.Please include a contact number if you are willing to speak to a BBC journalist. You can also get in touch in the following ways:WhatsApp: +44 7756 165803Tweet: @BBC_HaveYourSayUpload your pictures/video hereOr fill out the form belowPlease read our terms & conditions and privacy policy

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SharecloseShare pageCopy linkAbout sharingInternational efforts are under way to help India as the country suffers critical oxygen shortages amid a devastating surge in Covid cases.The UK has begun sending ventilators and oxygen concentrator devices. EU members are also due to send aid.The US is lifting a ban on sending raw materials abroad, enabling India to make more of the AstraZeneca vaccine.India’s capital Delhi has extended its lockdown as overcrowded hospitals continue to turn patients away. The government has approved plans for more than 500 oxygen generation plants across the country to boost supplies. Meanwhile neighbouring Bangladesh has announced that it will close its border with India from Monday to prevent the spread of the virus.Patients die without oxygen amid Delhi Covid surgeA city where breathing has become a luxuryViral picture that defines India’s Covid distressIndia reported 349,691 more cases in the 24 hours to Sunday morning and another 2,767 deaths, however the true figures are thought to be much higher. What is the UK sending?The first consignment of aid left the UK on Sunday and is due to arrive in India on Tuesday. Further shipments will take place later in the week. The aid includes 495 oxygen concentrators – which can extract oxygen from the air when hospital oxygen systems have run out – as well as 120 non-invasive ventilators and 20 manual ventilators.”We stand side by side with India as a friend and partner during what is a deeply concerning time in the fight against Covid-19,” UK Prime Minister Boris Johnson said in a statement.The spike in infection has led to the cancellation of a planned visit by Mr Johnson to India and to a travel ban. Other nations, including the UAE, Canada, Germany and the Netherlands have also banned flights from India.Sights you never thought you’d see. An oxygen tanker with police escorts. More precious than gold. #india #covid19 pic.twitter.com/6hkTiH8iLF— Yogita Limaye (@yogital) April 25, 2021
The BBC is not responsible for the content of external sites.View original tweet on TwitterWhat about the US and others?The White House says it will immediately provide raw materials for vaccines to Indian vaccine manufacturers.”Just as India sent assistance to the United States as our hospitals were strained early in the pandemic, we are determined to help India in its time of need,” said President Joe Biden.It follows calls by Indian officials and the Serum Institute of India (SII) for the US to lift export controls on raw materials for vaccines that were put in place in February.Washington has also been criticised for delaying a decision on sending surplus vaccine doses abroad. The US has millions of unused doses of the AstraZeneca vaccine, which has not yet been approved for use there. Top infectious diseases expert Dr Anthony Fauci said the option of sending them to India was being considered.The US will also provide medical equipment and protective gear. France meanwhile says it will provide oxygen.image copyrightReutersIn Brussels, the European Commission said it planned to send oxygen and medicine too. Its head Ursula von der Leyen said the organisation was “pooling resources to respond rapidly to India’s request for assistance”.India’s neighbour Pakistan – which has tense relations with Delhi amid territorial disputes – offered medical equipment and supplies and its Prime Minister Imran Khan tweeted prayers for a “speedy recovery”. The country’s Edhi foundation has also offered to send a fleet of 50 ambulances to India.Today we have sent the first of several urgent deliveries of surplus medical equipment to our friends in India to help provide life-saving care for vulnerable Covid patients. No-one is safe until we are all safe. pic.twitter.com/HOudeYv86c— Dominic Raab (@DominicRaab) April 25, 2021
The BBC is not responsible for the content of external sites.View original tweet on TwitterIndia in crisisDelhi is extending its lockdown for a second weekPM Narendra Modi urged people to exercise caution and get vaccinatedThe Fortis Escorts Heart Institute, a private hospital in Delhi, said on Sunday it would not admit any more patients because of a shortage of oxygen At least 20 people died on Saturday at the Jaipur Golden Hospital in Delhi because of a lack of oxygenWhat is the situation in India?In Delhi – a region of about 20 million people – hospitals are full and are turning away new patients. At least two hospitals have seen patients die after oxygen supplies ran out.Relatives of sick people are appealing on social media for hospital places, oxygen supplies and ventilators. Some streets outside medical facilities have become crowded with the seriously ill, their loved ones trying to arrange stretchers and oxygen supplies for them as they plead with hospital authorities for a place inside.Meanwhile testing capacity has also been overwhelmed and crematoria are working around the clock.Jayant Malhotra has been helping at one crematorium in Delhi.”I’ve never seen such a terrifying situation. I can’t believe we’re in the capital of India. People aren’t getting oxygen and they’re dying like animals,” he told the BBC.Similar scenes are playing out in other major cities. In total India has confirmed nearly 17 million infections and 192,000 deaths. Some states and territories have imposed lockdowns and other restrictions. image copyrightReutersHealth officials say more infectious variants have been driving the surge in infections, including the UK variant which has been found in Delhi, and a variant first detected in India in October. There has been growing criticism of Prime Minister Modi’s government for the country’s lack of readiness for the second wave. Large religious gatherings and political rallies have been taking place.Have India’s rallies helped spread coronavirus?What is the India Covid variant?On Sunday in a radio address Mr Modi said: “We were confident, our spirits were up after successfully tackling the first wave, but this storm has shaken the nation.”He also tweeted his condolences after it emerged that a famous classical Indian music singer, Rajan Mishra, had died in Delhi after suffering Covid-related health complications.India’s government has confirmed it asked Twitter to block tweets that were critical of the authorities’ handling of the crisis, saying the tweets had contained misinformation and were against Indian law. The social media platform blocked dozens of tweets from being seen in India – among them were tweets from a lawmaker named Revnath Reddy, a minister in the state of West Bengal named Moloy Ghatak and a filmmaker named Avinash Das, Reuters reported.Meanwhile a newspaper group said it was suspending coverage of the country’s flagship domestic cricket competition, the Indian Premier League, saying it was “incongruous” for the competition to be going ahead amid the surge.