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Toxic air to blame for lung cancer; no longer just a smoker’s disease

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delhi air pollution

Mumbai, Aug 3: Smokers and non-smokers now represent an equal number of lung-cancer patients, according to a study carried out by the Lung Care Foundation, a not-for-profit organisation focused on improving lung health in India.

An analysis of 150 patients at Sir Ganga Ram Hospital, New Delhi, found that close to 50 per cent of patients with lung cancer — the type of cancer responsible for the highest number of cancer deaths nationwide — had never smoked, and yet had developed the pulmonary disease.

Health professionals now believe there is strong evidence that points to the role of air pollution in the increasing incidence of lung cancer amongst the young and female populations.

“This is the first time I have seen this 1:1 ratio of smokers to non-smokers suffering from lung cancer,” Arvind Kumar, Chairman, Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, told IndiaSpend. “Looking at this data, the obvious reason that comes to mind is air pollution, which contains smoke and PM 2.5.”

PM 2.5 is particulate matter less than 2.5 microns in size, or 30 times finer than a human hair, which, when inhaled deeply into the lungs is known to cause lung cancer, cardiovascular and respiratory diseases. Outdoor pollution was classified as a cancer-causing agent in 2013 by the International Agency for Research on Cancer (IARC), a part of the World Health Organisation.

In November 2017, a public-health emergency was declared by the Indian Medical Association in Delhi as the air quality index breached 999, likened to smoking 50 cigarettes a day.

Currently, lung cancer is responsible for five deaths per 1,000 in India (seven per 1,000 in Delhi, a city that regularly experiences high levels of air pollution) and is accompanied by a survival rate of no more than five years.

The effects of air pollution on respiratory and lung health — typically associated with decades of smoking tobacco and tobacco-related products — have become a growing focus for medical researchers and health workers, as awareness of health hazards amongst the public has risen.

In 2013, an eight-year-old girl in China became the youngest person in that country, and possibly the world, to be diagnosed with lung cancer, as a result of exposure to polluted air. She lived beside a busy road and was over-exposed to PM 2.5.

Nearly 21 per cent of patients analysed in the new study are under 50 years old. Of this group, five out of 31 patients are between 21 and 30 years of age, representing 3.3 per cent of the total patient group.

Compare this to 70 years ago, when the proportion of cancer patients under 30 was 2.5 per cent, according to a study conducted across 15 teaching hospitals between 1955-59.

Lung cancer is typically associated with older patients, since the harmful chemicals found in cigarettes cause damage to cellular DNA over time, reducing the body’s ability to prevent the formation of cancerous cells. In the US, 82 per cent of all lung cancer patients are over 60 years of age and most are diagnosed at Stage III or IV of the disease.

The number of women contracting the disease appears to be increasing, data show. The male to female ratio of lung cancer patients went from 6.7:1 between 1958-85, to 3.8:1 between 2012-18.

In 2012, 3.2 per cent of women were smokers compared to a 23 per cent prevalence among men, according to a study at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Women are also less likely to be exposed to work environments which can increase the chances of developing cancer, such as mines and construction sites.

The increasing numbers of non-smokers now suffering from lung cancer, is another “disturbing trend” that points to factors beyond smoking tobacco as being the primary cause.

Of the total 150 patients surveyed, 50 per cent or 74 were non-smokers (meaning they had never smoked in their life). The proportion of non-smokers rose to 70 per cent among the younger age category (ie, less than 50 years old).

Among the reasons given in the study for non-smokers contracting lung cancer were exposure to radiation and asbestos and occupational hazards attached to mining, in addition to environmental factors such as heavy air pollution.

Lower numbers of patients suffering from squamous cell carcinoma (59) compared to adeno carcinoma (80) is a further indication of the link between increasing lung cancer and polluted air.

“Typically smoking used to cause squamous cell carcinoma, but we now see an increase in women and younger people with mostly adeno carcinoma (AC) and this shows their cases are not related to smoking, but pollution,” said Kumar.

AC is the most common form of cancer among non-smokers and increasing levels of ambient PM 2.5 have been proven to be associated with increasing incidence of AC, according to this 2016 paper in the European Respiratory Journal.

High 24-hour average levels of PM 2.5 is now a year-round problem for the national capital, with residents experiencing zero days of good quality air between March-May 2018.

Increased levels of lung cancer in the 20-30 age group and high prevalence of the AC pathology point towards a looming epidemic, the study warned. Late detection and misdiagnosis as tuberculosis are further aggravating the situation.

However, prevention and early detection is possible. Currently 70-80 per cent of patients are diagnosed at stage III and IV, and health professionals are calling for more screening and diagnosis to take place at stage I instead.

A cancer’s “stage” refers to its size and the extent to which it has spread, and it helps determine the level of treatment. At stage I, the cancer is between 3-4 cm, growing up to 5 cm at stage 2. From stage 3, the cancer begins to spread to the lymph nodes (important for immune response function) and at stage 4, the cancer may be present in both lungs or have had spread to other organs in the body.

“We hope studies like this will help us in going to the government and convincing them this is a public health emergency,” said Kumar.

The decision on whether to ban firecrackers — which emit PM 2.5 and contribute to heavy levels of pollutants in the air — during Diwali was heard in the Supreme Court on World Lung Cancer Day, August 1. The case is now listed for concluding arguments on August 8.

(In arrangement with IndiaSpend.org, a data-driven, non-profit, public interest journalism platform, with whom Tish Sanghera, a graduate of King’s College London, is an intern. The views expressed are those of IndiaSpend. Feedback at [email protected])

(IndiaSpend/IANS)

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Delhi’s Covid testing 4K short of actual capacity, says High Court

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Arvind Kejriwal Delhi

New Delhi, Oct 1 : The Delhi High Court yet again pulled up the city government for not using its actual testing capacity, noting that Delhi can conduct 15,000 RT-PCR tests per day while actual number of tests being done is still around 11,000.

“Delhi has the capacity of conducting 15,000 tests per day through RT-PCR mode… 4,000 RT-PCR tests per day are not being utilised, which does not make any sense when cases of Covid-19 infection during the period between September 14, 2020 to September 27, 2020, remain in the range of 3,500-4,000 cases per day with only one exception on September 20 when the positive cases reported were 2,548,” said a division bench of Justices Hima Kohli and Subramonium Prasad.

The court further noted that the report of Sero Surveillance-3 reflects a reduction of the IgG antibodies’ seroprevalence from 28.7 per cent to 25.1 per cent.

“The seroprevalence has declined in northwest and central districts but has increased in west, south, northwest and east districts,” it said.

As per the report submitted to the court, the seroprevalence was found to be more in females during the three rounds of Sero Surveillance and least in those aged 18 to 49 years, as compared to those aged below 18 years and above 50 years.

“The conclusion in the Sero Surveillance-3 report is that there is a need to enhance the focus on sample representativeness of the survey in the central, northeast and north districts,” the court said.

In its report filed before the court, the city government said that Geospatial Delhi Ltd has incorporated the changes made in the draft map, in terms of the feedback received from various districts and the said map of available testing in Delhi was received by the Delhi government on September 28.

“The map mentions a total of 320 testing sites in Delhi. The said map has been shared with DMRC for being displayed at permanent locations/sites at all major Metro Stations. It has also been sent to the Delhi State Mission and uploaded on various websites of the Delhi Government,” the order noted.

The Delhi government also told the high court that providing access to Covid-19 testing through Mohalla Clinics and Community Centres is under the active consideration of the Expert Committee constituted by the Lt. Governor. “But no final decision on the way forward for capacity building and ramping up the overall testing strategy in Delhi has been taken,” the government, represented by Additional Solicitor General Sanjay Jain and Additional Standing Counsel Satyakam, submitted.

While posting the matter for further hearing on October 7, the high court has asked the ASG to inform the court of the date finalised for commencing the next Sero Surveillance in Delhi.

“Since we are informed that the Expert Committee is actively involved in re-strategising the testing capacity as also reviewing the overall strategy required to be followed by the Delhi government and request has been made to await the said recommendations, list on October 7, 2020,” said the court.

The directions came as the court was hearing a PIL filed by advocate Rakesh Malhotra seeking increasing Covid-19 testing numbers in the national capital and getting speedy results.

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US hails India partnership as crucial for global recovery from Covid-19

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Coronavirus India

New York, Oct 1 : The US on Wednesday hailed its partnership with India on protective equipment and medical supplies during the “desperate” early days of the Covid-19 pandemic as the “clearest example” of positive global collaboration rising from one of its “most important partnerships in the world”.

The current US outlook frames India as a crucial partner for bouncing back from the pandemic’s deadly blow.

“India has been an important partner for the United States since the early days of the pandemic when countries were desperate for factual information about the virus and searching for personal protective equipment and other medical supplies,” a senior US State Department Official said during a background briefing on the ‘US-India Comprehensive Global Strategic Partnership’.

“Looking forward to the next six months and beyond. We know that our continued close cooperation with India will be an important part of the global recovery from the pandemic,” the US official said.

The US-India “collaborative approach on therapeutics” is being underlined as an “excellent example” of positive global impact.

“American company, Gilead has granted voluntary non-exclusive licensing agreements to Indian pharmaceutical companies to produce a generic form of remdesivir,” according to the State Department official.

According to Gilead, these licensing agreements grant to Alkem Laboratories Ltd., Aurobindo Pharma Ltd., FDC Ltd., J.B. Chemicals and Pharmaceuticals Ltd., Matrix Laboratories Ltd., Medchem International, Ranbaxy Laboratories and Shasun Chemicals and Drugs Ltd. the rights to produce and distribute generic versions of tenofovir disoproxil fumarate (tenofovir DF) to 95 low-income countries around the world, including India.

India’s Prime Minister Narendra Modi, while addressing the UN General Assembly last week, pledged to help the world produce and deliver potential coronavirus vaccines.

India is the world’s largest vaccine producer. Serum Institute of India, the world’s largest maker of vaccines by volume, is mass-producing a vaccine for low and middle-income countries. The company is deep into late-stage studies of AstraZeneca’s COVID-19 vaccine candidate.

Against a tumultuous backdrop of an ongoing pandemic and global economic ruin, the US is highlighting the “enormous strengths” of the US-India relationship.

“Every time we look at these problems we find another area or solution we’re working together makes us both stronger, and the United States and India both see the danger of missing the opportunity to link our great societies and economies more closely,” the US official told reporters.

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Moderna COVID-19 vaccine appears safe, shows signs of working in older adults – study

Moderna is already testing the higher dose in a large Phase III trial, the final stage before seeking emergency authorization or approval.

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COVID-19 Vaccine

Results from an early safety study of Moderna Inc’s MRNA.O coronavirus vaccine candidate in older adults showed that it produced virus-neutralizing antibodies at levels similar to those seen in younger adults, with side effects roughly on par with high-dose flu shots, researchers said on Tuesday.

The study, published in the New England Journal of Medicine, offers a more complete picture of the vaccine’s safety in older adults, a group at increased risk of severe complications from COVID-19.

The findings are reassuring because immunity tends to weaken with age, Dr. Evan Anderson, one of the study’s lead researchers from Emory University in Atlanta, said in a phone interview.

The study was an extension of Moderna’s Phase I safety trial, first conducted in individuals aged 18-55. It tested two doses of Moderna’s vaccine – 25 micrograms and 100 micrograms – in 40 adults aged 56 to 70 and 71 and older.

Overall, the team found that in older adults who received two injections of the 100 microgram dose 28 days apart, the vaccine produced immune responses roughly in line with those seen in younger adults.

Moderna is already testing the higher dose in a large Phase III trial, the final stage before seeking emergency authorization or approval.

Side effects, which included headache, fatigue, body aches, chills and injection site pain, were deemed mainly mild to moderate.

In at least two cases, however, volunteers had severe reactions.

One developed a grade three fever, which is classified as 102.2 degrees Fahrenheit (39°C) or above, after receiving the lower vaccine dose. Another developed fatigue so severe it temporarily prevented daily activities, Anderson said.

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