ওমিক্রন – কোভিড-১৯ এর নতুন ভেরিয়েন্ট: আমাদের কতটা চিন্তিত হওয়া উচিত?

ঠিক সেই সময়ে যখন বিশ্বজুড়ে মানুষ মহামারীর উদ্বেগ থেকে কিছুটা স্বাভাবিক জীবনে ফিরতে শুরু করেছিল, ঠিক তখনই দক্ষিণ আফ্রিকা থেকে একটি নতুন SARS-CoV-2 ভাইরাসের খবর প্রকাশিত হয়েছে। 

২৬ নভেম্বর, বিশ্ব স্বাস্থ্য সংস্থা (ডব্লিউএইচও) ভাইরাসের এই নতুন স্ট্রেইন আখ্যায়িত করে এর নাম দিয়েছে ওমিক্রন। ওমিক্রন এখন অন্যান্য সাতটি ভ্যারিয়েন্টের সাথে যুক্ত হয়েছে, যার মধ্যে আগে ছিল আলফা, বিটা, গামা এবং ডেল্টা ভ্যারিয়েন্ট।

খবরে প্রকাশিত হয়েছে সর্বশেষ ‌এই ভ্যারিয়েন্টটির অসংখ্য মিউটেশন আছে যার ফলে এটি সহজেই সংক্রমণযোগ্য এবং এটি রোগ প্রতিরোধ ক্ষমতাকে সহজে ভেদ করতে পারে। এসব কারনেই বর্তমানে ভ্যারিয়েন্টটি বিশ্বজুড়ে উদ্বেগ সৃষ্টি করেছে। দৈনন্দিন জীবনে এর কেমন প্রভাব পড়বে তা জানার জন্য মানুষ দিন দিন আগ্রহী হয়ে উঠছে।

এর আগে বিশ্ব স্বাস্থ্য সংস্থা (ডব্লিউএইচও) এর তথ্য মতে ভেরিয়েন্টগুলিকে ‘ভ্যারিয়েন্ট অব কনসার্ন ‘ বা উদ্বেগজনক ভ্যারিয়েন্ট হিসাবে শনাক্ত করা হয়েছিল এবং মিডিয়া আকর্ষণের মূলে আসার আগে ভ্যারিয়েন্টগুলো নিয়ে যথেষ্ট গবেষণা করারও সময় পাওয়া গিয়েছিলো। তবে এবার ওমিক্রন এর বিষয়টি দুই সপ্তাহেরও কম সময়ে ঘটেছে।

omicron

কেন ওমিক্রন একটি “উদ্বেগজনক ভ্যারিয়েন্ট”?

ওমিক্রন এর স্পাইক প্রোটিনে ৩২ টি মিউটেশন পাওয়া গেছে। যদিও এর মধ্যে কিছু অন্য ভ্যারিয়েন্টের সাথে মিশ্রণ ঘটিয়েছে, তবে বেশিরভাগই নতুন ধরনের মিউটেশন। 

ওয়েন্ডি বার্কলে যিনি বর্তমানে যুক্তরাজ্যে করোনাভাইরাস ভেরিয়েন্ট নিয়ে গবেষণার প্রতিনিধিত্ব করছেন, উদ্বেগ প্রকাশ করে বলেছেন, ওমিক্রন ভ্যারিয়েন্ট এর স্পাইক প্রোটিনের পরিবর্তন হয় ফলে নতুন মিউটেশন ঘটে এবং এন্টিবডিকে দুর্বল করে দেয়। তিনি সতর্ক করেছেন যে, বিজ্ঞানীদের যে কোন সিদ্ধান্তে আসার আগে অনেক গবেষণা করতে হবে।

নতুন ভ্যারিয়েন্টের বিরুদ্ধে ভ্যাকসিন কী কাজ করবে?

উহান থেকে SARS-CoVID-2-এর প্রথম খবর পাওয়ার পর থেকে, গত দুই বছরে একাধিক ভ্যারিয়েন্ট আবিষ্কৃত হয়েছে এবং আমরা আশা করতে পারি নতুন ভ্যারিয়েন্ট এর আগমন ঘটতেই থাকবে।

ভ্যাকসিন দ্রুত তৈরি করা হয়েছে এবং অন্যান্য প্রতিষেধকও আসছে। নতুন ধরনের ভেরিয়েন্টের বিরুদ্ধে ভ্যাকসিনের কার্যকারিতা যদিও কম, তবে রোগ প্রতিরোধ ক্ষমতা বাড়াতে বুস্টার ডোজও সংযুক্ত করা হয়েছে। নতুন ভেরিয়েন্টের এর বিস্তারিত প্রতিক্রিয়াগুলি খুঁটিয়ে দেখার জন্য যথেষ্ট সময়ও হাতে নেই।

এই মুহূর্তে, এমন অনেক প্রশ্ন আছে যার উত্তর আমাদের হাতে নেই। বর্তমানে বিভিন্ন গবেষণা প্রক্রিয়া চলছে যা অনেকগুলি প্রশ্নের উত্তর দিতে সক্ষম হবে। গুরুত্বপূর্ণ কিছু প্রশ্নের উত্তরে যা পাওয়া যাবে:

  • বর্তমান ভ্যাকসিন দ্বারা প্রদত্ত সুরক্ষা স্তর
  • এই ভাইরাসে আক্রান্ত রোগীদের রোগের মাত্রা
  • ওমিক্রনের সংক্রমণযোগ্যতা

ইতিমধ্যে, ফাইজার এবং মর্ডানা সহ প্রধান কোভিড ভ্যাকসিন নির্মাতা সংস্থাগুলো ‘শুধু মাত্র ওমিক্রন’ এর ভ্যাকসিন তৈরিতে কাজ করছে যা প্রায় ৩ মাসের মধ্যে সবার কাছে পৌঁছে যাবে বলে আশা করা যায়। সাম্প্রতিক একটি সাক্ষাৎকারে, ফাইজারের প্রধান বৈজ্ঞানিক কর্মকর্তা মিকাইল ডলস্টেন বলছেন, ২০২২ এর মার্চের মধ্যে একটি ওমিক্রন কেন্দ্রিক বুস্টার পাওয়া যেতে পারে। সম্ভবত এবার এফডিএ ভ্যাকসিনগুলির ব্যাপকহারে ক্লিনিকাল ট্রায়াল এর ক্ষেত্রে ছাড় দিবে।

নিজেকে নিরাপদ রাখতে কী করতে পারি?

CDC বুস্টারগুলির নেওয়ার ব্যাপারে জোর দিয়েছে। সংস্থ্যাটি বলেছে যে কোন প্রাপ্তবয়স্কর ক্ষেত্রে মর্ডানা বা ফাইজার/বাওন্টেক-এর ভ্যাকসিনের প্রাথমিক দুই ডোজ শেষ করার ছয় মাস পরে অথবা জনসন অ্যান্ড জনসন-এর একক-ডোজ ভ্যাকসিন নেয়ার দুই মাস পর বুস্টার শট নেওয়া উচিত।

এখন পর্যন্ত, আমরা জানি যে মাস্ক পরা, হাত ধোয়া এবং শারীরিক দূরত্বের মতো সতর্কতাগুলি মেনে চলতে পারলে, ভাইরাসের কারণ হতে পারে এমন কোনও মিউটেশন ঘটার সম্ভাবনা নেই। এই নির্দেশিকাগুলি মেনে চলতে পারলে ওমিক্রন ভ্যারিয়্যান্ট থেকেও রক্ষা পাওয়া যেতে পারে।

আমার কী ওমিক্রন নিয়ে উদ্বিগ্ন হওয়া উচিত?

যদিও ওমিক্রনের প্রভাব আমাদের মহামারী থেকে স্বাভাবিক জীবনে ফিরে আসার লড়াইয়ে একটি বাধা হয়ে দাড়িয়েছে তবুও জনস্বাস্থ্য কর্মকর্তারা বিশ্বাস করেন যে, ভাইরাসটি টিকা এবং আগের সংক্রমণের ইমুনাইজেশান থেকে পুরোপুরি অব্যাহতি দেয়ার সম্ভাবনা কম।

টিকা দেওয়ার হার বৃদ্ধি এবং প্রতিশ্রুতিশীল ওষুধের কারণে, ওমিক্রন এর প্রভাব আলফা এবং ডেল্টার তুলনায় অনেক কম কষ্টকর হওয়া উচিত। বুস্টার শটগুলি উন্নত স্তরের অ্যান্টিবডি তৈরির দিকে নিয়ে যাবে যা ভাইরাসকে দূর্বল করে দেবে, এবং আরও বিভিন্ন ধরণের অ্যান্টিবডি তৈরি করবে যা নতুন ভ্যারিয়েন্টগুলির বিরুদ্ধে সুরক্ষা দেবে।

মার্কিন প্রেসিডেন্ট জো বিডেন সম্প্রতি এক সংবাদ বিবৃতিতে বলেছেন ওমিক্রন “চিন্তার কারণ তবে আতঙ্কের কারণ নয়।”  তিনি আরো বলেন “এই নতুন ভেরিয়েন্ট, এর বাইরের যে কোনও ভ্যরিয়েন্ট, বর্তমান যে কোন ভ্যরিয়েন্টের বিরুদ্ধে সবচেয়ে বেশি সুরক্ষা আমরা পেতে পারি সম্পূর্ণরূপে টিকা দেওয়া এবং বুস্টার শট নিশ্চিত করার মাধ্যমে।”

সাউথ আফ্রিকার ভিডিও সহ আভ্যন্তরীণ রিপোর্ট

Op-ed: Why Bangladesh Should Be Concerned About the Emerging COVID Variants

Since January 2021, Bangladesh has confirmed the presence of five COVID-19 variant strains — Alpha (B.1.1.7) (aka the “UK variant”), Beta (B.1.351) (aka the “South Africa variant”), (B.1525), Gamma (P.1) (aka the “Nigeria variant”), and Delta (B.1.617.2) (aka the “India variant”). These variants raise concern because of their high transmissibility and infection potential. Public Health England reports that the Alpha variant, for example, is approximately 25 to 40 percent more transmissible than the first recorded strain of the COVID-19 virus.

Transmission rates are not the only concern regarding these variants— they may also cause more severe disease. Most recently, Public Health England reported that the Delta variant was not only more transmissible among close contacts than the Alpha strain, but was also associated with higher hospitalization rates in England and Scotland. According to sequencing data, the second wave in India was mainly powered by the Alpha and Delta variants, both currently present here in Bangladesh. Scientists use genomic sequencing data to decode genes and unlock information about how viruses function. Sequence data allows scientists to identify SARS-CoV-2 and its mutations, study how it affects the virus’s composition, and understand how it influences human health.  

Praava Health is concerned about the emergence of new variants and their impact on COVID testing and the spread of the disease in Bangladesh and beyond. To date, Bangladesh has contributed over 4,000 samples to global sequencing data – a level of sequencing that is sadly exceptionally low for a population the size of Bangladesh’s. Of the 172 countries that have uploaded sequencing data for 1.2 million cases, many report less than 1% of their cases. Bangladesh’s sequencing is much lower with only .005% of all cases being submitted to GISAID, the global repository for COVID-19 genome sequencing. 

To expand and contribute to our collective knowledge on the circulating variants in Bangladesh, Praava is collaborating with a research foundation, CHRF, to determine which variants are captured in the COVID samples processed by Praava Health and to determine the fidelity of COVID testing in the light of the emerging variations in viral genome and the effect on population health. Data from Praava is contributing to GISAID, a global, open-access repository of SARS-CoV-2 genome sequences. 

In Bangladesh, the border areas of Dhaka are now facing the brunt of the rising trend of COVID-19 cases. Khulna Division has emerged as the most impacted, with a test positive rate of 36.05%. On the other hand, Dhaka is so far the least impacted of all the divisions, with an infection rate of 7.02%. As we have witnessed in neighboring India, a catastrophic epidemic can result in tremendous fatalities. To prevent similar outcomes, Bangladesh must act quickly specifically by increasing our vaccination efforts.

The World Health Organization (WHO) states that getting vaccinated is one of the best ways to protect yourself and others from COVID-19. Most of the COVID-19 vaccines target the spike protein on the surface of the virus and help your immune system develop neutralizing antibodies that protect you from infection. However, the variants have multiple mutations on this surface spike protein and the impact of these mutations on vaccine effectiveness is a topic of ongoing research. Preliminary unpublished reports from laboratory studies (as well as emerging clinical data) suggest that currently approved vaccines still retain their effectiveness against the variants, though at a lower magnitude of protection. Nonetheless, it appears that vaccines can protect patients from the variants’ severe effects and lower the rates of hospitalization and deaths.

Vaccine supplies must be transferred now to the areas where the crisis is most severe. Although children and young adults are far less likely than adults to be hospitalized with COVID-19, we should begin vaccinating them with the same urgency and large-scale coordination efforts as adults if we want to reduce COVID-19 cases and eventually halt the pandemic.

Half-hearted preventive measures are a major reason behind the worsening COVID situation in the country. While vaccines are important, masks and social distancing are equally effective against variants too. The fastest approach to recover from the pandemic is to combine these mitigation tactics with vaccination. The sooner we act, the likelier we are to return to normalcy. 

Get tested for COVID-19 & Travel with peace of mind

After receiving government approval, Praava has tested over 50,000 individuals for COVID-19 before their travels abroad. Get tested and travel stress-free with quick results delivered directly to your mobile phone. 

Things you need to know to get tested:

  • This service is only available at our family health center in Banani.
  • Samples must be collected no longer than 72 hours and no fewer than 24 hours prior to your time of departure.
  • Sample collection will take place between 8:00 am to 4:00 pm every day.
  • Reports will be delivered to you via SMS, Praava’s mobile app, and also by email in 12 hours from the time of your sample collection.
  • It will also be uploaded to the DGHS website.

To get tested at Praava, all passengers must provide

  • A photocopy of your passport 
  • A photocopy of your ticket
  • For Bangladeshi passport holders, a hard copy of your NID

Please also bring your original passport with you. You need to submit copies of your documents to the sample collectors at Praava when you’re getting tested. Unfortunately, we are NOT ABLE to accept soft copies of your documents and ticket.

Terms and conditions

  • Home sample collection is not available for travelers’ tests as per the instructions of the Directorate General of Health Services (DGHS). 
  • At the time of collection, please keep your original passport at hand and fill out the form. Using a photocopy of your passport is NOT permitted by DGHS.
  • Travelers with positive reports in the last 7 days will not be allowed to fly.
  • You can test again after 7 days if you tested positive, exclusively in a government-run lab. You will be permitted to travel once you tested negative for COVID-19 and have received the report.  

Please refer to the DGHS instruction for travelers for more details.

In order to travel out of Bangladesh, you must carry:

  • A hard copy of your report from Praava
  • A hard copy of your QR code included report from DGHS

You will need both the reports from DGHS and from Praava. Download your DGHS report online or get both your DGHS and Praava report together at Praava’s facility once the report is ready. 

How to get your DGHS report online? 

You can download your DGHS report from their website using the following steps:

  • On the website please enter the same phone number that you have used for booking your COVID-19 test at Praava
  • A One Time Password (OTP) will be generated and sent to your phone for verification (valid For 3 minutes)
  • After you have confirmed your verification, you will be able to access your report
  • Please make sure all the information on the report is correct 
  • If any information on the report is incorrect and requires changing, please immediately contact us at 10648

Please note that the email report generated from Praava is only for self-reference and soft copies of the report will not be accepted by the immigration authorities. You must have printed copies of both DGHS and Praava reports with you in order to board your flight. 

Stay healthy and stay safe. We hope to continue to serve you during this difficult time and want to remind you that at Praava, you are more than a patient, you are family.

In good health,

The Praava Health Team

What We Know About Post-COVID ‘Long-haulers’

It has been more than a year since the COVID-19 pandemic spread like wildfire around the world. According to the World Health Organization (WHO), since December 2019, when the first case of COVID-19 was identified in Wuhan, China, more than 119 million people have been infected and more than 2.6 million people succumbed to the virus. 

After more than a year, we have come to know a lot about this virus, but we are still learning something new every day. In most cases, adults who are infected with COVID-19 experience mild symptoms that last for about 10 days, while in some cases, people can have more severe symptoms that last for up to 20 days.

However, in some very rare cases, patients experience lingering symptoms that last for one, two, or even three months. This group includes those who have experienced both mild and severe cases. Initially, these lingering symptoms were ignored as a real medical issue. As health experts step in to try to manage this group of patients and learn more, many are now referring to this group as coronavirus “long-haulers” or “long-COVID.” 

This concept is not unique; after many illnesses, including the common cold, influenza, and Epstein-Barr, post-viral symptoms can occur.

The most common symptom which persists is fatigue. However, body aches, shortness of breath, difficulty concentrating, inability to exercise, headaches, and difficulty sleeping are all symptoms of this condition. It is difficult to predict who will become a long hauler. According to an article in Science, people who were mildly affected by COVID-19 can still have lingering symptoms whereas severely ill people can be back to their normal health in two months. 

One of the symptoms described by these people is “brain fog,” one of the most confusing symptoms for long-haulers. Patients have reported saying they are unusually forgetful, confused, or can’t concentrate even when watching TV. This affects a wide range of COVID-19 patients, including those hospitalized and placed in intensive care, and those with mild symptoms that did not require hospitalization, adding to the confusion around this condition. Continued symptoms are more likely to occur in people over the age of 50, people with multiple chronic illnesses, and those who became very ill with COVID-19.

Two groups of people affected by the virus can be categorized as long-haulers:

  • Those who experience some permanent damage to their lungs, heart, kidneys, or brain that may affect their ability to function
  • Those who continue to experience debilitating symptoms despite no detectable damage to these organs

While the precise cause of these conditions cannot be determined, an early analysis by the United Kingdom’s National Institute for Health Research suggests that ongoing long-term COVID symptoms may be due to four syndromes:

At present, health officials are learning more about this condition to determine the best approach to help these COVID-19 long haulers. These patients need proper attention to help them, along with a holistic approach to treat their symptoms. With proper research, we hopefully will be able to provide better care to patients in the future and find a remedy for this condition. 

Answers To Your Concerns About The COVID-19 Vaccine

There has never been a time where the general public has gotten to know so much about vaccines. It has been hard to keep up with all the information about the COVID-19 vaccine and it has become challenging to know what’s true and what’s not.

Here are a few things to help you access the right information about the AstraZeneca COVID-19 vaccine:

How do I know if I am allergic to the COVID-19 vaccine?

If you have had a severe allergic reaction to any of the components of the vaccine then you should not have the AstraZeneca vaccine. 

Components of Oxford-AstraZeneca Vaccine are:

One dose (0.5 ml) contains:

COVID-19 Vaccine (ChAdOx1-S* recombinant) 5 × 1010 viral particles

* Recombinant, replication-deficient chimpanzee adenovirus vector encoding the SARS-CoV-2 Spike glycoprotein. Produced in genetically modified human embryonic kidney (HEK) 293 cells. This product contains genetically modified organisms (GMOs).

The other excipients are L-histidine, L-histidine hydrochloride monohydrate, magnesium chloride hexahydrate, polysorbate 80, ethanol, sucrose, sodium chloride, disodium edetate dihydrate, and water for injections.

If you have ever had a severe allergic reaction to another vaccine or injectable medication then consult with your doctor first. 

If you have an allergy to food, oral medications, or other triggers like dust, latex, etc, you can still get vaccinated. 

Anyone with a history of having had a severe allergic reaction should stay under observation for 30mins after taking the vaccine.

I have a chronic condition, is it safe to get the vaccine?

Those who have chronic medical conditions like diabetes or chronic kidney disease are more likely to suffer from severe COVID-19 and its complications, which makes it more important that you get vaccinated soon. Currently, there is no globally definitive treatment for this disease and vaccination is the only way to be able to curb this pandemic. Therefore, it is important that those with chronic conditions do get the vaccine. If you are unsure about your particular condition, then you can check this approved list by the UK National Health Service as well as discussing with your doctor. 

Do you have a weakened system due to cancer, HIV, or take immunosuppressive medications?

Specific data on those with a weakened immune system is not available yet however as these patients are at increased risk of severe COVID-19, they should not be excluded from getting the COVID-19 vaccine – rather, they should be prioritized. Patients should have a discussion with their doctor and be warned that they may have a reduced immune response to the vaccine and so these patients should be counseled to still wear a mask, physical distancing, and frequent handwashing even after getting the vaccine.

Why do I have to keep on social distancing and wearing masks after getting the vaccine?

The AstraZeneca COVID-19 vaccines help to decrease the severity of the disease. However, research is ongoing on whether the vaccines can prevent you from getting infected or transmitting the virus. Therefore, even after vaccination, you can still be a carrier of the virus and not display symptoms. Keeping this in mind, vaccinated persons can still transmit the virus to those who have not been vaccinated like children and pregnant women. 

If I have had COVID-19, do I still need to take the COVID-19 vaccine?

Yes. If you have previously had COVID-19, your body will have produced antibodies but these may only be present for 3 months. Therefore to prevent the chance of re-infection, it is recommended to get the COVID-19 vaccine. 

If I am sick on the day I am due to get my COVID-19 vaccination, can I still get it?

Being unwell is not a contra-indication to getting a COVID-19 vaccine, and it will not prevent the vaccine from working or increase the chance of side effects. However, it is best to wait until your symptoms have improved before you get vaccinated. If you are on antibiotics, you can still get the vaccination. 

How effective is the Astrazeneca vaccine against some of the new variants? 

According to CDC, we are still learning how effective the vaccines are against new variants of the virus that causes COVID-19. Early data show the vaccines may work against some variants but could be less effective against others. We are learning more each day about the characteristics of new variants.

Importance of getting vaccinated
  • It’s everyone’s responsibility to do their part and get vaccinated to help to contain the virus
  • COVID-19 vaccines are perhaps the best hope for ending the pandemic 

Experts estimate that herd immunity would require around 80-90% of the population to have COVID-19 immunity, either through prior infection or vaccination. That’s why experts are encouraging the public to get the COVID-19 vaccine. Herd immunity means that enough people in a community are protected from getting a disease because they’ve already had the disease or because they’ve been vaccinated. Herd immunity makes it hard for the disease to spread from person to person. It even protects those who cannot be vaccinated, like newborns or people who are allergic to the vaccine.

Allergy and COVID-19

Symptoms of flu, cold, and allergy are quite similar to those of COVID-19, so with every cough and sneeze, people wonder whether they have been infected with the coronavirus. Allergies normally cause symptoms such as runny nose and sinus but generally do not result in fever, as is mostly seen with COVID-19 or flu.

Bangladesh is a developing country with 150 million population. About 20% to 25% of population is suffering from different types of allergic disorder. They suffer almost all year round from different kinds of symptoms. 

Allergy vs COVID 19:

COVID-19 is a highly contagious and viral disease which can spread via air, respiratory droplets, or close personal contact. The symptom onset is around 2-14 days after exposure to the virus. Allergies on the other hand is a non-contagious hypersensitive reaction to the immune system when one is exposed to their trigger or allergen such as pollen, dust, mold, etc. Allergy symptoms are usually more localized, ranging from mild to severe, and can occur seasonally or be present year-long.

For instance, a patient with COVID-19 may have a fever, body aches, chills, a sore throat, weakness, and respiratory symptoms, while someone with allergies will be more likely to have the symptoms centered on the eyes, nose, and throat, and they usually don’t have a fever. Furthermore, in cases of allergy, symptoms improve when administering antihistamines but this does not help patients with COVID-19.

Although some coronavirus symptoms are similar to allergies, there are many variations. The image below from the CDC compares symptoms caused by allergies and COVID-19.

Some key points to differentiate allergies from COVID-19:

History
People often suffering from allergies have a personal history of allergy from allergens like food, pollen, dust, etc, and other atopic diseases. They may also have had previous similar allergy attacks or have a family history of atopy or allergy. COVID-19 is an extremely viral and contagious virus that can spread from person to person without any personal history. 

Symptoms
Allergies typically make people itchy which is not a symptom for COVID-19. People with allergies may also have asthma which can cause coughing, breathlessness, chest pain and tightness, and wheezing. Even though most are similar symptoms, COVID-19 typically does not develop wheezing.

Medication
Allergy symptoms can be treated with allergy medication like antihistamines and steroids. On the other hand, there is yet no proven medication or vaccine that can cure COVID-19.  

Some study shows the clinical course of COVID in allergic patients is associated with a worsening of allergies, for example, exacerbation of asthma. Even so, a clear understanding of COVID-19 infection in allergic patients compared to non-allergic patients is limited, and more clinical evidence is needed.

CDC recommends wearing masks as masks also offer some protection against seasonal allergies because they can prevent some larger particles from being inhaled. Discard your masks after each use, particularly if you suffer from seasonal allergies, because the covering may carry particles such as pollen.

The best way to prevent or treat allergy symptoms is to avoid the allergen. On the other hand, the best way to prevent COVID 19 infection is wearing masks, washing hands for at least 20 seconds, and maintaining social distancing. Finally, anyone who has any illness or symptoms must make sure to quarantine at home to avoid spreading the germs.

The immunity puzzle during COVID-19: jigsaw pieces for our immune system

As the pandemic stretches on, our online feed is overflowing with “quick fixes” to boost our immunity. Sadly, the sources for such solutions are often unclear and may thus be misleading. The “Clinical Dietician” world has also responded but with nutritional guidelines based on scientific research and unprecedented worldwide cooperation. These guidelines could thus help improve our understanding of how to build immunity better for the long term.

Nutrition does boost immunity but what I have to tell my patients is that the link is complicated. It is impacted by the multi-functional interactions of our cells, organs, tissues and molecular build in dealing with our environmental pathogens. Stress, obesity, age, genetics and time of the day can also affect it. Balanced eating, regular physical exercises and quality sleep often go hand in hand to reinforce immunity.

For vulnerable groups, such reinforcements are now crucial, especially amongst those aged 65 and above, with underlying health conditions, such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, chronic kidney and liver disease or who are immunosuppressed. Based on existing research, specific vitamins and minerals in our food intake can target such vulnerabilities individually or synergistically which I refer to in more detail below. 

Insufficient dietary intake of micronutrients such as vitamins and minerals can compromise immune functions and increase the overall risk of infection. The micronutrients which are pivotal for strengthening the immune system are vitamins A, C, D, E, B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin) and B9 (folic acid) and minerals iron, selenium, zinc, magnesium and copper- these are found in a variety of foods as shown below and should be part of a healthy balanced diet. Individuals should not take extra supplements without consulting a doctor or dietitian.

Vitamins

VitaminPurposeFood SourcesContext 
AInsufficient amount in our diet increases susceptibility to a range of infections.Preformed – Animal foods such as liver and fat portions of dairy foods(milk, cheese, butter), egg yolk and fish. Provitamin A and β-Carotene– Dark yellow, red, green and orange pigment in plants such as carrots, spinach, pumpkin, tomatoes, broccoli. Should be taken with 3g of fat (e.g. oil, ghee, butter) to be absorbed properly.Cooking helps release the vitamin from plants making them available for absorption.
B2/ riboflavinFirst-line host immune response against invading pathogens; helps iron absorption.Milk and cheese.70% B2 will be lost by exposure to sunlight.
B6/ pyridoxineHelps in the production of antibodies and immune cells.Whole grains (brown flour and rice, oats), pulses (chickpeas, lentils dry beans) and legumes (green beans and peas, soybeans), bananas, potatoes and meat (poultry). 
B9/ folic acidMaintain the balance of the immune system and increase resistance to infections.Dark green leafy vegetables (spinach, cabbage, cauliflower, broccoli), citrus fruits (oranges), tomatoes, cantaloupe and legumes (green beans and peas, soybeans). Some cereals and bread are fortified with folic acid.Folate absorption depends on its source with only 50% being absorbed from plant sources. Older people are unable to absorb enough due to low gastric acid therefore intake should be more
B12/  cobalaminModulates immunity against viruses and bacteria.Only in animal food – meat, poultry, fish, milk, eggs and cheese.Individuals who are vegan or have low gastric acid levels (older population) are unable to meet daily requirements.
C/ ascorbic acidReduces risk, severity and duration of upper and lower respiratory tract infections.Requirements increase during infections.Citrus fruits (oranges and lemons), sweet potatoes, guava, strawberries, mangoes, papaya, capsicum, broccoli.Can be easily destroyed by heat, light and action of oxygen in the air. Cook for a limited amount of time.
DReduces risk of respiratory tract viral infections, therefore, improving immune functions.‘The sunshine vitamin’, as its source is the sunlight. Only a few other natural sources such as fish liver oils and egg yolks (only small amounts). Sources can be oily fish like trout and freshwater river carps.Staying indoors in a lockdown can deprive us of the daily requirements of sunlight. It is recommended to take a supplement of 10 mcg = 400 IU (International Units). The recommended daily amount of vitamin D is 400 IU for children up to age 12 months, 600 IU for ages 1 to 70 years, and 800 IU for people over 70.
EPotent antioxidant modulating host immune functions.Vegetable oils (canola, sunflower, safflower) and lower amounts in olive oil and corn oil. Also nuts (peanuts, hazelnuts and almonds), green vegetables (spinach and broccoli), sunflower seeds. Some breakfast cereals, spreads and fruit juices are fortified with vitamin E.Benefits the elderly, may reduce the risk of upper respiratory tract infections.

Minerals

Mineral typePurposeFood SourcesContext
IronProduces immune cells that attack foreign bacteria in the body. Non-Heme Iron: spinach and legumes  Heme Iron: fish, poultry, eggs  Heme iron improves the absorption of non-heme iron, so its deficiency in diets should be monitored. Also, an acidic environment increases iron absorption (iron taken with vitamin C) while severe infection depresses it.
ZincEven a marginal zinc deficiency can impact immunity as it leads to increased diarrhoea and respiratory morbidity.Sources can be seafood (shellfish-lobster, crab and oysters), meat, lamb, leafy and root vegetables, pumpkin seeds, eggs and milk.Zinc is better absorbed from animal protein than plant protein. Zinc supplements can interfere with iron and copper absorption and vice versa. Older individuals with optimum zinc status have greater resistance to infections and less need for antibiotics. Excessive zinc intake, especially from supplements, can lead to a suppressed immune system.
SeleniumAn integral part of antioxidants that protects the cell and lipid membrane from oxidative damage. Selenium influences the innate and acute immune systems. Selenium partners with vitamin E.Meat and meat products, fish, poultry, eggs and Brazil nuts.Lacto-ova vegetarians and vegans may be at risk of deficiency.
MagnesiumSome functions of the immune system are dependent on magnesium.Almonds, cashew nuts, green vegetables and spinach, pulses (beans, red, green, yellow and brown lentils, peas), whole grain cereals (wheat, corn, barley, oats, rye and millet).Deficiency associated with cardiac arrhythmias and cardiac arrest.
CopperEssential for optimal innate immune function.Liver, seafood, nuts and seeds.a deficiency increases susceptibility to bacterial infection.
Probiotics (live microflora) and prebiotics‘Desirable’ bacteria benefiting the gastrointestinal tract by promoting the proliferation of good bacteria and limiting the development of harmful bacteria preventing the colonisation of pathogens. Prebiotics – Bananas, onions and garlic. Dietary sources of probiotics can be cultured milk and yogurt, cheese, pickled cabbage and tempeh.Probiotics may be effective in treating infectious diarrhoea. Individuals with compromised immune function should not use probiotics without medical supervision. Accurate information regarding the dosage and requirements and safety of particular supplements are still uncertain.

Dietary considerations for COVID-19 positive patients at home

  1. Optimization of nutritional status: Energy and protein need individually adjusted according to body weight, age, disease status, energy expenditure, and tolerance to reduce the risk of complications.
  2. High calorie and high protein diets are important for patients with COVID-19 to protect against the breakdown of muscles. Try eating 6 times a day every 2-3 hours. Protein intake of at least 75-100 grams from sources that include meat, fish, poultry, eggs, milk, and yoghurt.
  3. Hydration: 2-3 liters of fluids per day (2-4 ounces every 15 minutes). Fever is associated with excess loss of fluid which may lead to dehydration. Caution should be used for individuals who have fluid restrictions.
  4. Proper nutrition adjusted on an individual basis can help reduce carbon dioxide levels and improve breathing (high fat and low carbohydrate diet).
  5. Supplementation with vitamins and minerals: vitamins A, B, C, and D, also omega-3 polyunsaturated fatty acids, as well as selenium, zinc, and iron should be considered in the assessment of micronutrients in COVID-19 patients.
  6. Physical activity: For people in quarantine, every day > 30 min or every second day > 1h exercise is recommended to maintain fitness, mental health, muscle mass, and thus energy expenditure and body composition.
  7. Oral nutritional supplements or enteral feeding should be considered for people whose nutritional needs cannot be met orally.

This article was published in The Daily Star authored by Tazreen Yusuf Mallick, Praava Health’s Nutritionist. She also worked in the NHS, United Kingdom as a registered clinical dietician.

Praava Introduces COVID Sample Collection Booths Across Dhaka

We understand how the rapidly changing situation during this pandemic is overwhelming for all of us. Praava is here for you.

To serve you better during this challenging time, we have introduced new COVID sample collection booths along with our home sample collection option.

Our COVID sample collection booths are spread across the city so that it is easy for you to access from your neighborhood. Below are the details of our booths:

Booths where you can walk-in and provide samples:

Kuril 
Prescription Care
Address: Ka-62, Kuril Chowrasta, Kuril, Dhaka-1219
Days: Every day
Time: 10am – 5pm

Mirpur  
Address: 2-F, Road 7, Love Road, Mirpur 2, Dhaka
Days: Every day
Time: 10am – 5pm

Mohammadpur
Address: Modina villa-3, Flat no-A1, House-09, Road-1, Char Rasta, Chadd Uddan, Mohammadpur, Dhaka-1207
Days: Every day 
Time: 10am – 5pm

Uttara
Address: 38 Shahjalal Avenue, Sector 04, Uttara, Dhaka
Days: Every day
Time: 10am – 5pm

You can also book an appointment for your samples to be collected directly from your home. We are now collecting samples for one person per household as well. Currently, for single sample collection, we are now providing a limited time discount of BDT200 and an additional BDT150 discount for new Patients, so the new price is BDT4300. If home sample collection is for more than one person in the same household, you will get a discount of BDT350 per collection and an additional BDT150 discount for new Patients, so the new price is 4150. 

To book a test for a collection booth or home sample collection, you can call 10648, or book online

We are all growing weary of the situation, but please remember that the best way to protect yourself from contracting COVID-19 is to practice social distancing, which means staying home except for essential activities and, when necessary to be in public, deliberately increasing the physical space between you and others to avoid contracting or spreading illness. Additionally, wash your hands often with soap and warm water for at least 20 seconds, or use an alcohol-based hand sanitizer; and avoid touching your face, eyes, nose, and mouth with unwashed hands.

Stay healthy and stay safe. We hope to continue to serve you during this difficult time and want to remind you that at Praava, you are more than a Patient, you are family.