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Russian vaccine not in advanced stages, says WHO

WHO and partners have included nine experimental COVID-19 vaccines within an investment mechanism it is encouraging countries to join, known as the Covax facility. The initiative allows countries to invest in several vaccines to obtain early access, while theoretically providing funding for developing countries. The World Health Organization says the vaccine approved by Russia this week is not among the nine that it considers in the advanced stages of testing.

WHO and partners have included nine experimental COVID-19 vaccines within an investment mechanism it is encouraging countries to join, known as the Covax facility. The initiative allows countries to invest in several vaccines to obtain early access, while theoretically providing funding for developing countries.

“We don’t have sufficient information at this point to make a judgment” on the Russia vaccine, said Dr. Bruce Aylward, a senior adviser to WHO’s director-general.

“We’re currently in conversation with Russia to get additional information to understand the status of that product, the trials that have been undertaken and then what the next steps might be.”

This week, President Vladimir Putin announced Russia had approved a coronavirus vaccine that has yet to complete advanced trials in people and claimed, without evidence, the immunization protects people for up to two years.

Health

Russia Claims 1st Covid Vaccine “Sputnik V”; Putin’s Daughter Inoculated

Russian vaccine works effectively enough: President Putin
A Russian health care regulator has become the first in the world to approve a vaccine for the coronavirus, President Vladimir V. Putin announced on Tuesday, though the vaccine has yet to complete clinical trials.

The Russian dash for a vaccine has already raised international concerns that Moscow is cutting corners on testing to score political and propaganda points.

Mr. Putin’s announcement came despite a caution last week from the World Health Organization that Russia should not stray from the usual methods of testing a vaccine for safety and effectiveness.

Mr. Putin’s announcement became essentially a claim of victory in the global race for a vaccine, something Russian officials have been telegraphing for several weeks now despite the absence of published information about any late-phase testing.

“It works effectively enough, forms a stable immunity and, I repeat, it has gone through all necessary tests,” Mr. Putin told a cabinet meeting Tuesday morning. He thanked the scientists who developed the vaccine for “this first, very important step for our country, and generally for the whole world.”

Mr. Putin also said that one of his daughters had taken the vaccine.

The Russian vaccine, along with many others under development in a number of countries in the effort to alleviate a worldwide health crisis that has killed at least 734,900 people, sped through early monkey and human trials with apparent success.

But the Russian scientific body that developed the vaccine, the Gamaleya Institute, has yet to conduct Phase III tests on tens of thousands of volunteers in highly controlled trials, a process seen as the only method of ensuring a vaccine is actually safe and effective. Around the world, more than 30 vaccines out of a total of more than 165 under development are now in various stages of human trials.

Vaccines generally go through three stages of human testing before being approved for widespread use. The first two phases test the vaccine on relatively small groups of people to see if it causes harm and if it stimulates the immune system. The last phase, known as Phase III, compares the vaccine to a placebo in thousands of people. This final phase is the only way to know with statistical certainty whether a vaccine prevents an infection. And because it’s testing a much larger group of people, a Phase III trial can also pick up more subtle side effects of a vaccine that earlier trials could not.

The Food and Drug Administration in the United States has said that a new coronavirus vaccine would need to be 50 percent more effective than a placebo in order to be approved.

Russia’s minister of health, Mikhail Murashko, has said the country will begin a mass vaccination campaign in the fall, and said on Tuesday that it would start with teachers and medical workers this month.

The World Health Organization maintains a comprehensive list of worldwide vaccine trials. In the latest version of the list, there is no Russian Phase III trial.

Western regulators have said repeatedly that they do not expect a vaccine to become widely available before the end of the year at the earliest. Regulatory approval in Russia, well ahead of that timeline, could become a symbol of national pride and provide a lift for Mr. Putin, whose popularity ratings have fallen steadily under the weight of the pandemic and a faltering economy.

Health

Scientists figure out a weakness of coronavirus: Ordinary water

In a study, scientists discovered that about 90% of the Covid-19’s particles die in room temperature water in the course of 24 hours
Furthermore, scientists confirmed that boiling water containing Covid-19 kills it immediately and completely.

As the race for a potential Covid-19 vaccine continues in order to curb the spread of the novel coronavirus pandemic, scientists have managed to find out an important weakness of the virus, according to a report.

Researchers from Russia’s VECTOR State Research Center of Virology and Biotechnology in Novosibirsk, Siberia have figured out that ordinary water can help restrict the growth of the virus, according to Sputnik News report.

In their study, scientists discovered that about 90% of the virus’ particles die in room temperature water in the course of 24 hours, with 99.9% succumbing within 72 hours. Furthermore, scientists confirmed that boiling water containing Covid-19 kills it immediately and completely.

Significantly, researchers also found that although the virus does not multiply in dechlorinated and sea water, it can remain viable for some time, with its lifespan depending directly on the water’s temperature. Chlorinated water is also said to be highly effective at killing the virus, the report said.

The findings of the researchers were presented recently by Rospotrebnadzor, Russia’s consumer protection and human wellbeing watchdog.

In the Covid-19 vaccine front, the country has been showing significant results in vaccine trials.

According to reports, Russian Health Minister Mikhail Murashko said Gamaleya Institute of Epidemiology and Microbiology, a state research facility in Moscow, had completed clinical trials of the Covid-19 vaccine and paperwork is being prepared to register it.

He also said that they are preparing a mass vaccination campaign against the novel coronavirus for October, said Reuters citing local news agencies’ reports. Murashko adde that the authorities are considering getting doctors and teachers vaccinated against the virus first, according to a report.

A source told Reuters this week that Russia’s first potential Covid-19 vaccine would secure local regulatory approval in August and be administered to health workers soon thereafter.

Meanwhile, Russia registered 5,462 Covid-19 cases, bringing the cumulative total to 845,443, the country’s coronavirus response centre said on Saturday.

The country reported 95 new deaths from the novel coronavirus on Saturday, pushing its national tally to 14,058

Health

Oxford University Scientists Say Coronavirus Vaccine Prompts Protective Immune Response in Early Test

Scientists at Oxford University say their experimental coronavirus vaccine has been shown in an early trial to prompt a protective immune response in hundreds of people who got the shot.

British researchers first began testing the vaccine in April in about 1,000 people, half of whom got the experimental vaccine. Such early trials are usually designed only to evaluate safety, but in this case experts were also looking to see what kind of immune response was provoked.

In research published Monday in the journal Lancet, scientists said that they found their experimental COVID-19 vaccine produced a dual immune response in people aged 18 to 55.

“We are seeing good immune response in almost everybody,” said Dr. Adrian Hill, director of the Jenner Institute at Oxford University. “What this vaccine does particularly well is trigger both arms of the immune system,” he said.

Hill said that neutralizing antibodies are produced — molecules which are key to blocking infection. In addition, the vaccine also causes a reaction in the body’s T-cells which help to fight off the coronavirus. He said that larger trials evaluating the vaccine’s effectiveness, involving about 10,000 people in the U.K. as well as participants in South Africa and Brazil are still underway. Another big trial is slated to start in the U.S. soon, aiming to enroll about 30,000 people.

How quickly scientists are able to determine the vaccine’s effectiveness will depend largely on how much more transmission there is, but Hill estimated they might have sufficient data by the end of the year to decide if the vaccine should be adopted for mass vaccination campaigns.

He said the vaccine seemed to produce a comparable level of antibodies to those produced by people who recovered from a COVID-19 infection and hoped that the T-cell response would provide extra protection.

“There’s increasing evidence that having a T-cell response as well as antibodies could be very important in controlling COVID-19,” Hill said. He suggested the immune response might be boosted after a second dose; their trial tested two doses administered about four weeks apart.

Hill said Oxford’s vaccine is designed to reduce disease and transmission. It uses a harmless virus — a chimpanzee cold virus, engineered so it can’t spread — to carry the coronavirus’ spike protein into the body, which should trigger an immune system response.

Hill said Oxford has partnered with drugmaker AstraZeneca to produce their vaccine globally, and that the company has already committed to making 2 billion doses.

“Even 2 billion doses may not be enough,” he said, underlining the importance of having multiple shots to combat the coronavirus.

“There was a hope that if we had a vaccine quickly enough, we could put out the pandemic,” Hill said, noting the continuing surge of infections globally. “I think its going to be very difficult to control this pandemic without a vaccine.”

Numerous countries including Germany, France, the Netherlands, Italy, U.S. and the U.K. have all signed deals to receive hundreds of millions of doses of the vaccine — which has not yet been licensed — with the first deliveries scheduled for the fall. British politicians have promised that if the shot proves effective, Britons will be the first to get it.

Last week, American researchers announced that the first COVID-19 vaccine tested there boosted people’s immune systems just as scientists had hoped and the shots will now enter the final phase of testing. That vaccine, developed by the National Institutes of Health and Moderna, produced the molecules key to blocking infection in volunteers who got it, at levels comparable to people who survived a COVID-19 infection.

About a dozen different experimental vaccines are in early stages of human testing or poised to start, mostly in China, the U.S. and Europe, with dozens more in earlier stages of development.

British officials said Monday they had also signed a deal to buy 90 million doses of experimental COVID-19 vaccines being developed by the pharmaceutical giant Pfizer and others.

In a statement, the British government said it had secured access to a vaccine candidate being developed by Pfizer and BioNTech, in addition to another experimental vaccine researched by Valneva.

Health

WHO acknowledges ’emerging evidence’ of coronavirus transmission through air

GENEVA: The World Health Organization on Tuesday acknowledged “evidence emerging” of the airborne spread of the novel coronavirus, after a group of scientists urged the global body to update its guidance on how the respiratory disease passes between people.
“We have been talking about the possibility of airborne transmission and aerosol transmission as one of the modes of transmission of COVID-19,” Maria Van Kerkhove, technical lead on the COVID-19 pandemic at the WHO, told a news briefing.

The WHO has previously said the virus that causes the COVID-19 respiratory disease spreads primarily through small droplets expelled from the nose and mouth of an infected person that quickly sink to the ground.
But in an open letter to the Geneva-based agency, published on Monday in the Clinical Infectious Diseases journal, 239 scientists in 32 countries outlined evidence that they say shows floating virus particles can infect people who breathe them in.
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Because those smaller exhaled particles can linger in the air, the scientists are urging WHO to update its guidance.
Speaking at Tuesday’s briefing in Geneva, Benedetta Allegranzi, the WHO’s technical lead for infection prevention and control, said there was evidence emerging of airborne transmission of the coronavirus, but that it was not definitive.
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“…The possibility of airborne transmission in public settings – especially in very specific conditions, crowded, closed, poorly ventilated settings that have been described, cannot be ruled out,” she said.
“However, the evidence needs to be gathered and interpreted, and we continue to support this.”
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Any change in the WHO’s assessment of risk of transmission could affect its current advice on keeping 1-metre (3.3 feet) of physical distancing. Governments, which rely on the agency for guidance policy, may also have to adjust public health measures aimed at curbing the spread of the virus.
Van Kerkhove said the WHO would publish a scientific brief summarising the state of knowledge on modes of transmission of the virus in the coming days.
“A comprehensive package of interventions is required to be able to stop transmission,” she said.
“This includes not only physical distancing, it includes the use of masks where appropriate in certain settings, specifically where you can’t do physical distancing and especially for healthcare workers.”

Health

Trump administration begins formal withdrawal from World Health Organization

(CNN) The Trump administration has notified Congress and the United Nations that the United States is formally withdrawing from the World Health Organization, multiple officials tell CNN, a move that comes amid a rising number of coronavirus cases throughout the Americas over the past week.

The withdrawal, which goes into effect next July, has drawn criticism from bipartisan lawmakers, medical associations, advocacy organizations and allies abroad. Presumptive Democratic presidential nominee Joe Biden vowed Tuesday to reverse the decision “on (his) first day” if elected.

Sen. Robert Menendez, the top Democrat on the Senate Foreign Relations Committee tweeted the news Tuesday.

“Congress received notification that POTUS officially withdrew the U.S. from the ⁦‪@WHO⁩in the midst of a pandemic. To call Trump’s response to COVID chaotic & incoherent doesn’t do it justice. This won’t protect American lives or interests—it leaves Americans sick & America alone,” he wrote.

A State Department official also confirmed that “the United States’ notice of withdrawal, effective July 6, 2021, has been submitted to the UN Secretary-General, who is the depository for the WHO.” The spokesperson for Secretary-General António Guterres said he had received the notice and “is in the process of verifying with the World Health Organization whether all the conditions for such withdrawal are met.” Those conditions “include giving a one-year notice and fully meeting the payment of assessed financial obligations.”

Republicans urge Trump not to terminate relationship with World Health Organization
Republicans urge Trump not to terminate relationship with World Health Organization
The letter addressed to the UN is very short, around three sentences, a source briefed on the correspondence told CNN, and it triggers a one-year withdrawal timeline. However, this source also cautioned that they cannot confirm they saw the final version of the letter.

Among its current functions, the WHO is attempting to coordinate efforts to get personal safety and medical equipment, like ventilators, to hospitals around the world. Elizabeth Cousens, the president and CEO of the UN Foundation, said the organization is “indispensable” in the fight against Covid-19.

Loyce Pace, president and executive director of Global Health Council, echoed that point, telling CNN: “Thousands of people have spoken, from health experts to heads of state and heroes on the frontlines: the world needs WHO. This move signals a dangerous gamble in the midst of a pandemic we have yet to conquer, and without a viable alternative to WHO.”

Some have warned that withdrawal in the current environment could also interfere with clinical trials essential for developing vaccines, as well as efforts to trace the spread of the virus globally.

President Donald Trump said he was halting funding to the organization in mid-April and announced his intention to withdraw from the WHO in May after he said it “failed to make the requested and greatly needed reforms.” Trump had denounced the US’ contribution to the WHO — $400-500 million — in comparison to China’s and consistently accused the organization of aiding China in allegedly covering up the origins of the virus and allowing its spread.

While lawmakers from both parties have long cited systemic problems with the WHO, many have also denounced the President’s decision to withdraw during a once-in-a-century global pandemic.

Democratic House Speaker Nancy Pelosi called it “is an act of true senselessness.” Republican Sen. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, said he disagreed with Trump’s decision.

“If the administration has specific recommendations for reforms of the WHO, it should submit those recommendations to Congress, and we can work together to make those happen,” he said.

Last month, despite alleging that the World Health Organization “enabled” the Chinese government’s sweeping cover-up of the coronavirus pandemic’s origins, members of the GOP China task force urged Trump to reconsider his decision to terminate relations with the international body, arguing that the US can do more to affect change as a member.

Cousens, the head of the UN Foundation, called the decision “short-sighted, unnecessary, and unequivocally dangerous” and said that the US’ “ability to lead and shape an agenda for reform is drastically diminished when they step out of the field of play.”

“There’s no question but that working within an institution like the World Health Organization allows the United States and others to leverage their resources to have much greater impact,” she told CNN.

She pointed to the WHO’s work in “distributing millions of pieces of personal protective equipment to medical facilities around the world, millions of diagnostic tests, tracking the virus’ spread across borders, coordinating global efforts to develop a vaccine, … coordinating research among over 100 countries … along with all of the work that they do in low resource and more humanitarian settings.”

Move comes as virus is surging
The heads of the American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians and American College of Physicians condemned the move to withdraw from the WHO, saying in a statement that it “puts the health of our country at grave risk.”

“This dangerous withdrawal not only impacts the global response against COVID-19, but also undermines efforts to address other major public health threats,” they said in a joint statement. “We call on Congress to reject the Administration’s withdrawal from the WHO and make every effort to preserve the United States’ relationship with this valued global institution. Now is the time to invest in global health, rather than turn back.”

The number of coronavirus cases continues to surge across the US and in various countries around the world.

There are at least 2,953,423 cases of coronavirus in the US, and at least 130,546 people have died from the virus in the country, according to Johns Hopkins University’s tally.

In the span of a week and a half, the number of US coronavirus cases reported each day has doubled, and officials are saying this is still the first wave of the pandemic.

Brazil’s Jair Bolsonaro tests positive for Covid-19 after months of dismissing the seriousness of the virus
Trump has repeatedly insisted that the rise of cases in the US is purely the result of increased testing, but a WHO official knocked down that claim on Monday.

WHO scientists and experts are scheduled to travel to China this weekend to investigate the origins of the novel coronavirus, WHO Director-General Tedros Adhanom Ghebreyesus announced on Tuesday.

Specifically, experts will be seeking to trace the narrative of how the coronavirus might have spread from the wild to possibly farm animals to humans, said Dr. Mike Ryan, executive director of WHO’s Health Emergencies Program.

Biden vows to reverse decision
The Trump administration has already diverted funding from the WHO and the process to formally withdraw will take a year to complete. Critics of the decision hope that the withdrawal decision will be reversed if Trump loses the presidential election in November. In a tweet Tuesday, Biden vowed to do so if elected.

“Americans are safer when America is engaged in strengthening global health. On my first day as President, I will rejoin the @WHO and restore our leadership on the world stage,” he wrote.

US allies have rallied to the support of the WHO, with a top diplomat from Germany calling for global solidarity and Italy’s Health Minister criticizing Trump’s decision as “serious and wrong”.

Trump’s decision to permanently terminate the US relationship with the WHO follows a years-long pattern of railing against global organizations, with the President claiming that the US is being taken advantage of. The President has questioned US funding to the United Nations and NATO, withdrawn from the Paris climate accord and repeatedly criticized the World Trade Organization.
By Zachary Cohen, Jennifer Hansler, Kylie Atwood, Vivian Salama and Sara Murray,
CNN’s Manu Raju, Richard Roth, Valentina DiDonato, Lauren Mascarenhas and Sarah Mucha contributed to this report.
CNN :

Health

Scientists scoff at Indian agency’s plan to have COVID-19 vaccine ready for use next month

By Sanjay KumarJul

NEW DELHI—The apparent speed at which an Indian government agency aims to test and approve a homegrown COVID-19 vaccine has created an uproar among scientists both in India, which is increasingly overwhelmed by the new coronavirus, and abroad. A letter leaked on Twitter on Friday suggests the first vaccines could be rolled out by 15 August, which would leave far too little time for proper testing, critics say. The Indian Academy of Sciences calls the timeline “unreasonable and without precedent.”

Six Indian companies are developing vaccines against COVID-19. Last week, the Indian government gave two of them, Bharat Biotech and Zydus Cadila, permission to start phase I and II human clinical trials of their most advanced vaccines, named covaxin and ZyCov-D respectively.

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For covaxin, Bharat Biotech has joined with the National Institute of Virology, which is part of the Indian Council of Medical Research (ICMR). (The company is separately developing COVID-19 vaccine candidates in collaboration with Thomas Jefferson University in Philadelphia and the University of Wisconsin, Madison.)

ICMR Director-General Balram Bhargava revealed the extremely tight deadline in a letter to hospitals designated to be involved in the Covaxin studies. “It is envisaged to launch the vaccine for public health use latest by 15 August 2020 after completion of all clinical trials,” Bhargava wrote. He asked the hospitals to fast-track all approvals for the vaccine and be ready to enroll participants “no later than 7 July 2020,” adding that “noncompliance will be viewed very seriously.”

But it’s absurd to think studies could show a vaccine to be safe and effective in less than 2 months, many scientists say. “In my knowledge, such an accelerated development pathway has never ever been done for any kind of vaccine,” says Anant Bhan, an independent ethics and policy researcher and past president of the International Association of Bioethics. “This seems really, really rushed.” The timeline “carries potential risks and provides inadequate attention to required safety procedures,” Bhan adds.

“Clinical trials cannot be rushed,” concurs Indian virologist and veteran vaccine researcher Thekkekara Jacob John, formerly of the Christian Medical College in Vellore. Even when expedited, phase I and phase II trials will take a minimum of 5 months, he says. The duration of a phase III trial would depend on several factors, including the number of subjects enrolled and decisions by a data safety monitoring board, but would probably add at least another 6 months, Jacob John says. “ICMR’s intentions may be good but the processes have been vitiated and the risk is it can derail the vaccine,” he says.

Critics believe the target date is political: 15 August is India’s Independence Day, when Prime Minister Narendra Modi traditionally climbs the ramparts of the Red Fort in Delhi to give a long speech touting his government’s achievements and make major announcements.

Health

Corona medicine remdesivir will be available by this month

Mylan will launch a generic version of Gilead Sciences’ Covid-19 antiviral remdesivir in India at 4,800 rupees, about 80% below the price tag on the drug for wealthy nations.
Mylan’s price was for 100-mg vials, but it was not immediately clear how many of those vials would be required for a full treatment course.
Last month, two Indian drugmakers, Cipla and privately held Hetero Labs, also launched generic versions of the treatment.

An employee of Egyptian pharmaceutical company Eva Pharma holds a pack containing vials of Remdesivir, a broad-spectrum antiviral medication approved as a specific treatment for COVID-19, at the company’s factory, which started producing the drug this week with a production capacity of up to 1.5 million doses per month.

Mylan said on Monday it would launch a generic version of Gilead Sciences’ Covid-19 antiviral remdesivir in India at 4,800 rupees ($64.31), about 80% below the price tag on the drug for wealthy nations.

California-based Gilead has signed licensing deals with several generic drugmakers in an effort to make remdesivir available in 127 developing countries.

Last month, two Indian drugmakers, Cipla and privately-held Hetero Labs, also launched generic versions of the treatment. Cipla will price its version, Cipremi, at less than 5,000 rupees, while Hetero has priced Covifor at 5,400 rupees.

Gilead, last week, priced remdesivir at $2,340 per patient for rich nations and agreed to send nearly all of its supply of the drug to the United States over the next three months.

Mylan’s price was for 100-mg vials, but it was not immediately clear how many of those vials would be required for a full treatment course. Gilead has said for a five-day treatment course, a patient would need six vials of remdesivir.

Remdesivir is in high demand after the intravenously-administered medicine helped to shorten hospital recovery times in a clinical trial but there have been concerns over its supply.

Mylan said it would manufacture remdesivir in India at its injectables facilities and was working toward expanding access for patients in the 127 low- and middle-income countries where it is licensed by Gilead Sciences to do so.

The Drug Controller General of India approved Mylan’s remdesivir version, to be called Desrem, for the treatment of suspected or laboratory-confirmed severe incidences of Covid-19 in adults and children, the company said in a statement.

India is the world’s third worst hit nation, with the number of coronavirus cases surging to 697,413 on Monday

Health

ICMR’s revised guidelines for Covid-19 patients

New Delhi: With a large number of people showing no symptoms testing positive for COVID-19, the Union Health ministry has revised home isolation guidelines to include asymptomatic positive patients in the list of mild or pre-symptomatic coronavirus infection cases.

However, immuno compromised patients (included HIV, transplant recipients, cancer therapy) are not eligible for home isolation, state the revised guidelines released on Thursday.

Elderly patients aged above 60 years and those with co-morbid conditions such as hypertension, diabetes, heart disease, chronic lung/liver/kidney disease and cerebro-vascular disease among others shall only be allowed home isolation after proper evaluation by the treating medical officer.

Patients under home isolation will stand discharged after 10 days of onset of symptoms and no fever for three days, the guidelines stated.

“Thereafter, the patient will be advised to isolate at home and self-monitor their health for further seven days. There is no need for testing after the home isolation period is over,” the ‘Revised Guidelines for Home Isolation of Very mild/pre-symptomatic/asymptomatic COVID-19 cases’ stated.

According to the document, asymptomatic patients like the ones who are pre-symptomatic and have very mild symptoms can opt for home isolation if they have the requisite self-isolation facility at their residence so as to avoid contact with other family members.

The guidelines come against India’s rising COVID-19 tally to 6,04,641 on Thursday, with a single-day increase of 19,148 cases, just five days after it crossed the 5 lakh-mark. The death toll due to the disease rose to 17,834 with 434 new fatalities, according to health ministry data updated at 8 am.

According to the guidelines, a caregiver should be available to provide care on 24×7 basis and a communication link between the caregiver and a hospital is a prerequisite for the entire duration of home isolation.

Besides, the guidelines reiterated that the caregiver and all close contacts of such cases should take hydroxychloroquine as a preventive medication as per the protocol and as prescribed by the treating medical officer.

Besides, it called for downloading the Arogya Setu mobile application and that it should remain active at all times (through bluetooth and wi-fi).

Patients should monitor their health and regularly inform the health status to the district surveillance officer, who will facilitate further follow up by the surveillance teams.

The patient also has to give an undertaking stating that being diagnosed as a confirmed/suspect case of COVID-19, he/she hereby voluntarily undertakes to maintain strict self-isolation at all times for the prescribed period, the guidelines said.

Immediate medical attention must be sought if serious signs or symptoms, including difficulty in breathing, dip in oxygen saturation, persistent pain/pressure in the chest, mental confusion or inability to arouse, slurred speech/seizures, weakness or numbness in any limb or face and developing bluish discolorations of lips/face, it stated.

As per the guidelines, the states and districts should monitor all such cases, and that the health status of those under home isolation should be monitored by the field staff/surveillance teams through personal visits along with a dedicated call centre to follow up on the patients on a daily basis.

The clinical status (body temperature, pulse rate and oxygen saturation) of each case should be recorded by the field staff/call centre.

The field staff will guide the patient on measuring these parameters and provide the instructions (for patients and their care givers), they said.

Besides, details about patients under home isolation should also be updated on COVID-19 portal and facility app (with DSO as user).

Mechanism to shift a patient in case of violation or need for treatment has to be established and implemented.

All family members and close contacts shall be monitored and tested as per protocol by the field staff. These discharge guidelines shall be strictly adhered to along with an issuance of a fitness certificate by the field team, as per the guidelines