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Some important aspects involved in restoring oxygen levels and Oxygen Therapy in COVID-19


Only 15% of COVID patients may have a moderate disease where one’s oxygen saturation level may go less than 94%.

During the second wave of COVID-19, an increase in oxygen requirement has been reported in patients. Dr Ravichandra, Chief Medical Officer, National Tuberculosis Institute, Bangalore explains: “80% of COVID-19 cases reported are mild. Only 15% of COVID patients may have a moderate disease where one’s oxygen saturation level may go less than 94%. And the remaining 5% COVID infected people may end up having a severe disease which shows respiratory rate higher than 30/minute and oxygen saturation level less than 90%.”

Let us take a look at some important aspects involved in restoring oxygen levels in the body, for the benefit of the small proportion of patients who end up needing supplemental oxygen.

Be alert to the Symptoms of Low Oxygen Level

Warning signs of low oxygen level include difficulty in breathing, confusion, difficulty in waking up and bluish lips or face. Adults may develop chest pain that doesn’t go away. Children may experience flaring up of nostrils, grunting while breathing or inability to drink or eat.

Why we should be concerned

According to WHO, Hypoxemia (low oxygen levels in the blood) may eventually result in loss of life. When oxygen levels become low because of a sickness such as COVID-19, the cells in the body don’t get enough oxygen to perform their normal functions. If the level remains low for long, maybe due to lack of treatment, organs start to malfunction; in severe cases, it may cause death.

Know How to Measure Oxygen Level

There are two easy ways to measure the oxygen level.

Pulse Oximeter: You can measure the oxygen level of a patient using a pulse oximeter which you can place on their finger, toe or earlobe. It’s a painless test, taking less than two minutes.

Pulse oximeters measure the oxygen saturation or percentage of oxygen in the patient’s blood. According to a WHO training manual on pulse oximetry, if the oxygen saturation is 93% or lower, the patient needs to be treated quickly. A saturation of less than 90% is a clinical emergency.

Respiratory Rate: Respiratory rate is the number of breaths a person takes per minute. Dr. Somashekhara, Director, National Tuberculosis Institute, Bangalore explains a simple method to measure the respiratory rate without any device. Keep your palm on your chest, measure your respiratory rate for 1 minute. If the respiratory rate is less than 24 per minute, your oxygen level is safe. If a patient has more than 30 breaths per minute, the oxygen level is low.

What to do when you face low oxygen level

Proning

Patients undergoing home care are advised to lie prone on their stomachs. This will improve breathing and increase oxygen saturation. Please check out more details in the Union Health Ministry’s “Proning for Self Care” advisory here.

According to Clinical Management Protocol for COVID-19 (in Adults), released by the Union Health Ministry on May 24, 2021, awake proning should be encouraged in all patients who require supplemental oxygen therapy.

The advisory by the Ministry of Health and Family Welfare also underlines important considerations while proning in non-intubated patients

Any COVID-19 patient with respiratory embarrassment severe enough to be admitted to the hospital may be considered for rotation and early self proning.
Care must be taken to not disrupt the flow of oxygen during patient rotation
Typical protocols include 30–120 minutes in prone position, followed by 30–120 minutes in left lateral decubitus (lying on left side), right lateral decubitus (lying on right side), and upright sitting position.
Using oxygen concentrators

Experts suggest that oxygen therapy may be given only in presence of a healthcare provider. However, one may use them in an emergency, while medical attention is being sought or while waiting for an ambulance.

Professor and Head of Department, Anaesthesia, B. J. Medical College, Pune, Prof. Sanyogita Naik advises: “Oxygen concentrators can be used only in moderate cases of COVID-19, when the patient experiences a drop in oxygen levels, where the oxygen requirement is a maximum of 5 litres per minute.”

The professor added that oxygen concentrators are also very useful for patients experiencing post-COVID complications which necessitate oxygen therapy.

In both the above cases, the goal of oxygen therapy is to achieve a saturation level of 94%; once the patient has a 93% to 94% oxygen level, the oxygen therapy may be discontinued. Excess of oxygen may lead to an increase in the level of Carbon Dioxide, leading to complications.




Passing out Parade of Spring Term 2021 held at Indian Naval Academy


The Presidents Gold Medal for the Indian Naval Academy B. Tech course was awarded to Midshipman Mohit Bhurariya.

In a spectacular Passing out Parade (POP) held at Indian Naval Academy (INA), Ezhimala, on Saturday, 29 May 21, 152 trainees comprising Midshipmen of 100 INAC, cadets of 30A  Naval Orientation Course (Extended) and 32 Naval Orientation Course (Regular) passed out with flying colours, marking the culmination of their ab-initio training.

The parade was reviewed by Vice Admiral Ajendra Bahadur Singh, AVSM, VSM, Flag Officer Commanding-in-Chief, Eastern Naval Command who awarded medals to meritorious Midshipmen and Cadets on completion of the Ceremonial Review. Vice Admiral M A Hampiholi, AVSM, NM, Commandant, INA was the Conducting Officer.

The Presidents Gold Medal for the Indian Naval Academy B. Tech course was awarded to Midshipman Mohit Bhurariya.

(a) CNS Silver medal for INAC B. Tech Course – Midshipman Rohit Dagar

(b) FOC-in-C South Bronze Medal for INAC B. Tech Course – Midshipman Gaurav Kumar

(c) CNS Gold Medal for NOC (Regular) – Cadet Akanksha Mehra

(d) Commandant, INA Silver Medal for NOC (Regular) – Cadet Ritika Mishra

(e) Zamorin Trophy for most promising women trainee – Cadet Vaishali Mishra

The successful trainees marched with their gleaming swords and rifles held in salute, past the Academy’s Quarterdeck, in Slow March, to the traditional notes of Auld Lang Syne – the poignant farewell tune played by Armed Forces around the world when bidding adieu to colleagues and comrades, for their Antim Pag or final step at the Indian Naval Academy.

Vice Admiral Ajendra Bahadur Singh, AVSM, VSM, Flag Officer Commanding-in-Chief, Eastern Naval Command congratulated the trainees on parade for their impeccable turnout, smart drill and movements on parade. The Reviewing Officer emphasised the core values of duty, honour and courage. He also highlighted that armed forces are the strongest pillar of defence of the country and have to deliver each and every time, whether it be a situation of conflict, escalation by inimical forces on the land or maritime borders or response to COVID pandemic, natural calamity, search and rescue which was witnessed during cyclone Yaas and Tauktae recently.

The Reviewing Officer and other dignitaries shipped the stripes of the passing out trainees and congratulated them for their successful completion of the rigorous training. These officers will proceed to various Naval ships and establishments to further consolidate their training in specialised fields. Stringent precautionary measures instituted by the Academy has helped in accomplishing the challenging goal of training cadets during COVID-19 and the successful culmination of the Spring Term 2021 at INA.




India logs 2.11L new cases, 3,847 Covid deaths


India’s overall tally of Covid-19 cases now stands at 2,73,69,093 with 24,19,907 active cases and 3,15,235 deaths so far.

India on Thursday reported 2,11,298 fresh cases as 3,847 more patients succumbed to the coronavirus in the last 24 hours, Union Health and Family Welfare Ministry said.

Tamil Nadu recorded the highest new cases with 33,764 people testing positive for the virus, while Kerala added 28,798 cases. Meanwhile Maharashtra saw most fatalities at 1,013, Karnataka added 530 and Tamil Nadu 475. Strict measures have been initiated by the M.K. Stalin government to bring down the Covid figures.

India’s overall tally of Covid-19 cases now stands at 2,73,69,093 with 24,19,907 active cases and 3,15,235 deaths so far.

According to the Health Ministry, a total of 2,83,135 people have been discharged in the last 24 hours, with 2,46,33,951 being cured from Covid till date.

The Health Ministry said that a total of 20,26,95,874 people have been vaccinated so far in the country, including 18,85,805 who were administered vaccines in the last 24 hours.

According to the Indian Council of Medical Research (ICMR), 33,69,69,353 samples have been tested up to May 26 for Covid-19. Of these 21,57,857 samples were tested on Wednesday.

In the last 16 days India has recorded over 60,000 deaths. On Monday, India crossed a grim milestone of three-lakh deaths due to the coronavirus infections, thus becoming world’s third country after the US and Brazil to cross three-lakh deaths.

On Tuesday, India recorded 1,96,427 cases — the lowest since April 14.

India registered record deaths due to Covid exactly a week back with 4,529 deaths — the highest number of fatalities from Covid infection in any country since the coronavirus outbreak was reported in China’s Wuhan in December 2019.

It surpassed 4,468 deaths in the US on January 12, and earlier 4,211 in Brazil on April 6. These three are the worst-hit by the pandemic.

After battling a brutal second wave for weeks, fresh Covid cases came down below the three lakh-mark for the first time on May 17 after touching record high of 4,14,188 on May 7.




Rahul Gandhi pays tributes to Nehru on his death anniversary


He was fondly called as ‘Chacha Nehru’ by children. His birthday on November 14 is celebrated as Children’s Day every year.

Former Congress president Rahul Gandhi on Thursday paid tributes to the country’s first Prime Minister Jawaharlal Nehru on his 57th death anniversary.

“Evil unchecked grows, evil tolerated poisons the whole system. Remembering the wise words of Pandit Jawaharlal Nehru on his death anniversary,” he said in a tweet.

Nehru was the first Prime Minister of independent India. He passed away on May 27, 1964 at the age of 74 in Delhi following a heart attack.

He was fondly called as ‘Chacha Nehru’ by children. His birthday on November 14 is celebrated as Children’s Day every year.




Over 10,000 inmates released to decongest UP jails


According to a Prison Department spokesman, nearly 8,463 undertrials have been released on bail, while 1,660 convicts were given a six-week parole.

Over 10,000 undertrials and convicts across jails in Uttar Pradesh have either been granted interim bail or parole in order to decongest the over-crowded prisons in the wake of the second wave of the Covid-19 pandemic.

This has been done in compliance with the Supreme Court directives.

According to a Prison Department spokesman, nearly 8,463 undertrials have been released on bail, while 1,660 convicts were given a six-week parole.

Of the total 10,123 released from 71 central and state prisons, a maximum of 704 undertrial inmates were freedon interim bail from the Ghaziabad district prison, 445 in Aligarh, 398 in Lucknow and 397 in Gautam Buddha Nagar.

There are more than 1 lakh inmates lodged in jails across the state.

The Department had come up with 54 temporary jails where suspects arrested in fresh cases are quarantined for 14 days before they were moved to permanent ones.

In a statement, the Department said the more than 24,000 inmates, above the age of 45, have been vaccinated.

Earlier, a high-powered committee, comprising Acting Chief Justice of Allahabad High Court Justice Sanjay Yadav, Additional Chief Secretary (Home) Avanish Kumar Awasthi and the state’s Director General (Prisons) Anand Kumar had sought a list of eligible prisoners in compliance with the Supreme Court directive.

A similar exercise was undertaken last year during the first Covid-19 wave when 11,000 prisoners were granted parole.




More than 50% mucormycosis patients recovered without steroids: Guj govt


It was also observed that 59 percent patients consisted of diabetes patients, 27.1 percent patients were immuno compromised and 15.2 percent were having co-morbidity.

The Gujarat government on Wednesday constituted a task force to bring uniformity in the treatment and protocols for the notified epidemic of mucormycosis in Gujarat. Also the health department released a study which said that more than 50 percent of mucormycosis patients recovered without the need for steroids to fight the fungal infection.

Following the central government’s advisory, the Gujarat government has notified mucormycosis or black fungus as an epidemic. More than half of the patients of mucormycosis in the country are from Gujarat.

Gujarat Chief Minister Vijay Rupani on Wednesday constituted an eleven member task force to bring uniformity in the treatment and protocols for the fungus.

The task force comprises of Dr Girish Parmar, the additional director and the Dean of Ahmedabad government dental college, Dr Kamlesh Upadhyay, Medicine, BJ Medical college, Ahmedabad, Dr Bela Prajapati, ENT, BJ Medical college, Dr Hansa Thakkar, opthalmologist, M&J Institute of Opthalmology, Dr Ashwin Vasava, Medicine, Surat government Medical college, Dr Anand Chaudhary, ENT, Surat government Medical college, Dr BI Goswami, Medicine, MP Shah, Jamnagar Medical college, Dr Sejal Mistri, ENT, PDU Medical college, Rajkot, Dr Neeti Sheth, opthalmologist, PDU Medical College, Rajkot, Dr Susheel Jha, ENT and Dr Neelesh V Parekh, opthalmologist, both from government medical college, Bhavnagar.

Meanwhile, based on the mucormycosis patients treated in the government hospitals of the state, the health department has come out with a report on the basis of which it is claimed that more than fifty percent (50.5%) patients did not require the use of steroids. Also, 66.5 patients did not require oxygen in getting treated.

It was also observed that 59 percent patients consisted of diabetes patients, 27.1 percent patients were immuno compromised and 15.2 percent were having co-morbidity.

It was also observed that 67.1 percent of patients were male while only 32.9 percent were female. Less than one percent (0.5) consisted of patients below 18 years age, 28.4 percent were 18 to 45 years age, the maximum patients of mucormycosis were 45 to 60 years at 46.3 percent and 24.9 percent consisted of more than sixty year old patients.




Cyclone Yaas: NDRF deploys 113 teams in 5 states, UT


The storm is likely to move north-northwestwards and weaken gradually into a cyclonic storm during the next six hours.

The National Disaster Response Force (NDRF) has deployed 113 teams in five states and a UT as part of its preparation and response to the severe cyclonic storm ‘Yaas’– the highest ever such deployment in the rescue operation.

These teams have been deployed in West Bengal, Odisha, Jharkhand, Andhra Pradesh, Tamil Nadu and Andaman and Nicobar Island.

Of the total teams, 104 are deployed on the ground while nine self-contained teams are on high alert within the states to tackle the situation as Cyclone ‘Yaas’ (pronounced as ‘Yass’) has completed its landfall and weakened from “very severe” cyclonic storm into “severe cyclonic” storm.

“These NDRF teams are constantly carrying out rescue and restoration work post cyclone in coordination with state and district administration,” the NDRF said in a statement.

As the cyclone hit, rainfall in the region has led to inundation of low-lying areas, it said, adding many trapped persons were rescued by the NDRF including an infant with other three family members who were rescued after their house collapsed due to heavy rain in Odisha.

Besides, the NDRF said, hundreds of stranded people were also rescued in the state of West Bengal.

“Three persons were also saved from drowning. NDRF has evacuated thousands of people to safer places in close coordination with local administration in both the states,” said the statement.

“Rescue operations are still continuing as large number of trees and electric poles are uprooted after the cyclone hit the land. Deployed teams are removing them from roads to keep communication lines clear and still this process is on. Rescuers are making all out efforts to bring normalcy in the areas.”

Director General NDRF Satya Narayan Pradhan has urged people to restrict their movement “till the situation becomes normal and take proper precautionary measures while returning to their homes”.

According to the India Meteorological Department (IMD) cyclone ‘Yaas’, which is crossing between Dhamra and Balasore in Odisha, made its landfall around 9 a.m. and weakened after three hours.

The storm is likely to move north-northwestwards and weaken gradually into a cyclonic storm during the next six hours.




Speciality centres to treat Mucormycosis to come up at LNJP, GTB and Rajiv Gandhi hospital: Delhi Govt


In view of rising incidents of Covid-19 associated Mucormycosis in the national capital, the Delhi government on Thursday announced to open dedicated centres for the treatment of black fungus at three large government-run hospitals.

Delhi Chief Minister Arvind Kejriwal, on Thursday, convened a high-level meeting to tackle the rising cases of black fungus in Delhi. Important decisions were taken for the prevention and treatment of this disease, such as the

In view of rising incidents of Covid-19 associated Mucormycosis in the national capital, the Delhi government on Thursday announced to open dedicated centres for the treatment of black fungus at three large government-run hospitals.

Chief Minister Arvind Kejriwal announced that the speciality centres would be open in LNJP Hospital, GTB Hospital, and Rajiv Gandhi Super Speciality Hospital.

The Delhi government said that these centres will ensure adequate management of medicines used in its treatment and take all measures to spread awareness among people about disease prevention measures.

The decision was taken in a review meeting Kejriwal held with the nodal minister for Covid management and Deputy CM Manish Sisodia, Health Minister Satyendar Jain, Chief Secretary and officials of the health and family welfare department.

The Kejriwal led government is also working on formulating Standard Operating Procedures (SOP)s for awareness and prevention of the disease.

“To tackle the rising cases of black fungus, the Delhi government has dedicated three hospitals for its treatment. Dedicated centres for mucormycosis treatment center will be established at LNJP, GTB and Rajiv Gandhi Hospital, with teams of specialized doctors constituted at each centre for efficient functioning. The Delhi government will also prepare a detailed plan and issue special SOPs on how to raise awareness amongst COVID-recovered people for the prevention of the disease,” the release shared by the government stated.

Meanwhile, the Kejriwal government will also procure medicines for the treatment of Mucormycosis from the Central government.

“Delhi is the capital of the country and so, people from outside also come here for treatment. We should have a sufficient quantity of medicines to cater to everybody who is coming for the treatment of black fungus,” the CM said.




Oxygen Expresses deliver nearly 12630 MT of Liquid Medical Oxygen across nation


It may be noted that around 200 Oxygen Expresses have completed their journey so far and brought relief to various States.

Overcoming all hurdles and finding new solutions, Indian Railways is continuing its journey of bringing relief by delivering Liquid Medical Oxygen(LMO) to various states across the country. So far, Indian Railways has delivered nearly 12630 MT of LMO in more than 775 tankers to various states across the country.

It may be noted that around 200 Oxygen Expresses have completed their journey so far and brought relief to various States.

Till the time of this release, 10 loaded Oxygen Expresses on run with more than 784 MT of LMO in 45 tankers.

Oxygen Expresses have been delivering more than 800 MT of LMO to the Nation each day now.

It is Indian Railways endeavour to deliver as much LMO as possible in the shortest time possible to the requesting states.

Oxygen relief by Oxygen Expresses reached out to 13 states namely Uttarakhand, Karnataka, Maharashtra, Madhya Pradesh, Andhra Pradesh, Rajasthan, Tamil Nadu, Haryana, Telangana, Punjab, Kerala, Delhi & Uttar Pradesh.

Till the time of this release, So far 521 MT of Oxygen has been offloaded in Maharashtra, nearly 3189 MT in UP, 521 MT in MP, 1549 MT in Haryana, 772 MT in Telangana, 98 MT in Rajasthan, 641 MT in Karnataka, 320 MT in Uttarakhand, 584 MT in Tamil Nadu, 292 MT in Andhra Pradesh, 111 MT in Punjab, 118 MT in Kerala and more than 3915 MT in Delhi.

Crisscrossing the country, Indian Railways is picking up oxygen from places like Hapa & Mundra in the West and Rourkela, Durgapur, Tatanagar, Angul in the East and then delivering it to States of Uttarakhand, Karnataka, Maharashtra, Madhya Pradesh, Andhra Pradesh, Rajasthan, Tamil Nadu, Haryana, Telangana, Punjab, Kerala, Delhi & Uttar Pradesh in complex operational route planning scenarios.

In order to ensure that Oxygen relief reaches in the fastest time possible, Railways is creating new standards and unprecedented benchmarks in running of Oxygen Express Freight Trains. The average speed of these critical Freight trains is way above 55 in most cases over long distances. Running on high priority Green Corridor, with a highest sense of urgency, operational teams of various zones are working round the clock in most challenging circumstances to ensure that Oxygen reaches in fastest possible time frame. Technical Stoppages have been reduced to 1 minute for crew changes over different sections.

Tracks are kept open and high alertness is maintained to ensure that Oxygen Express keeps zipping through.

All this is done in a manner that speed of other Freight Operation doesn’t get reduced as well.

Running of new Oxygen is a very dynamic exercise and figures keep getting updated all the time. More loaded Oxygen Expresses are expected to start their journeys later in the night.

Railways has mapped different routes with Oxygen supply locations and keeps itself ready with any emerging need of the States. States provide tankers to the Indian Railways for bringing LMO.




COVID challenge remains as long as infection exists even at minor scale: PM Modi


In his second round of interaction with district magistrates and field officials on the pandemic, Modi spoke about concerns in various quarters about any spread of infection in the young generation due to mutations in the virus and asked officials to analyse the statistics in their districts.

Prime Minister Narendra Modi on Thursday asked officials to record the spread of coronavirus infection and its seriousness among the youth and children and cautioned that the challenge posed by COVID-19 will remain as long it is present even at a “minor scale” in the country.

In his second round of interaction with district magistrates and field officials on the pandemic, Modi spoke about concerns in various quarters about any spread of infection in the young generation due to mutations in the virus and asked officials to analyse the statistics in their districts. They will have to be better prepared for the future, he said.

There have been reports that the virus may hit the young generation, demography which has so far not been affected as hard as the adult population with people in the older age bracket being seen as more susceptible.

Noting that active cases have seen a decline in the last few days, Modi referred to the experience of the last one-and-a-half years and told officials to work to ensure that people continue to follow COVID appropriate behaviour.

When the tally goes down, people start thinking that there is no need to worry now, he said, cautioning against it.

Modi called for collective responsibility in this regard among the government machinery, social organisations and elected representatives.

The challenge remains as long as the infection is present even at a minor scale, he said.

Noting that the pandemic has made their work more demanding and challenging, he said new strategies and solutions are needed to meet them and described the virus as “dhoort” (rogue) and “bahurupiya” (impersonator), a reference to its various mutations that has kept experts on edge.

Our strategy should be dynamic, and be undergoing continuous innovations and upgrades, he said.

Speaking on the vaccination programme, the prime minister said suggestions from states and other stakeholders have been incorporated and added that the Union Health Ministry is informing states about the availability of jabs 15 days in advance.

“With clarity about vaccination supply and timeline being available, vaccination management will become easier for you,” he said, adding that its supply will be further strengthened.

Modi also said that there is a need to prevent vaccine wastage, saying every dose wasted is denying someone protection shield against the disease.

Asking officials to analyse data separately for urban and rural regions besides those for tier 2 and 3 cities, Modi said it will help them prepare their strategy accordingly.

The prime minister stressed that officers use local experiences and also work together as a country. He also called for working to keep villages corona-free.
Modi praised the officials for their efforts in making good use of existing resources to fight “the biggest disaster in 100 years”.

The officials, who interacted with Modi via video conferencing, were from Chhattisgarh, Haryana, Kerala, Maharashtra, Odisha, Puducherry, Rajasthan, Uttar Pradesh, West Bengal and Andhra Pradesh. He had spoken to a group of field officials on Tuesday too.

The prime minister emphasised giving importance to people’s ease of living as well and said the facilities for free ration for the poor and other essential supplies must be provided.





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