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Cancer in India: A snapshot of the threat

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World cancer day 4 february text with violet ribbon symbol. Vector illustration concept for world cancer day. Typography design for poster banner and post on social media. Image credit: Tatiana Vasilyeva / 123rf. Cancer in India concept.
Image credit: Tatiana Vasilyeva / 123rf

India observes World Cancer Day 2021 in far from normal circumstances. The raging COVID-19 pandemic has threatened to obscure the plethora of other diseases India and the world at large grapples with. Awareness events such as World Cancer Day serve to shine a light on the far-reaching impact of cancer in India, which has emerged as one of the country’s most pressing and fastest-growing public health threats.

The growing rise of cases of cancer in India translates to one in ten Indians being affected by the disease in their lifetime and one in fifteen losing their lives. Recent decades saw cancer in India emerge as the country’s second-largest killer – and the country’s cancer burden is only expected to grow. 

As noted by Health Issues India on the occasion of World Cancer Day last year, “in 2018, 784,821 lives were lost to cancer in India with men accounting for 413,519 of these deaths and women for 371,302. Lip and oral cavity, lung, stomach, colorectal and esophageal cancers are the most common forms of the disease among men. Among women, the most common cancers are breast, lip and oral cavity, cervical, lung, and gastric. 

“Cancer is on the rise in India, a trend aligned with the growing incidence of noncommunicable diseases (NCDs) as a whole. By 2040, cases are expected to number at approximately twenty lakh compared to almost 11.6 lakh at present. In 2018, it was reported that India’s cancer burden had more than doubled in the preceding 26 years.” 

Cancer. Concept. Chemotherapy. Medical devices for advanced chemotherapy. By 2040, 670,000 Indians will need to be treated with chemotherapy for cancer. Image credit: Yuriy Klochan / 123rf
Medical devices for advanced chemotherapy. By 2040, 670,000 Indians will need to be treated with chemotherapy for cancer. Image credit: Yuriy Klochan / 123rf

A World Health Organization report published last year did, however, carry some good news for India in terms of its fight against cancer. As Health Issues India summarised at the time, “the report…ranks [India’s] population-based cancer registry as being of high quality; the country has an operational integrated plan for tackling NCDs and an operational national cancer control programme; and has delineated cancer management guidelines.”

The report, nonetheless, did outline “gaps in India’s response to cancer – one reflective of the problems linked to LMICs [low- and middle-income countries] which is expected to drive the expansion of its cancer burden.” Indeed, Health Issues India has reported on the need for an upgrade in cancer infrastructure and oncology human resources in India; to cope with enhanced demand, the country will need 7,300 oncologists in the years to come. The existing shortfalls mean as many as 83 percent of Indian cancer patients are failed when it comes to their treatment. 

The COVID-19 pandemic has only exacerbated the crisis. Early diagnosis was an area where India needed to make progress in the pre-pandemic era. “The major problem in our country is late diagnosis. Most patients come to us in the third or fourth stage, which further increases the disease intensity and burden. The regional centres cater to a limited population,” P.K. Jhulka, senior director of the Max Institute of Cancer Care, observed in March 2019.

Writing in The Times of India, Harmala Gupta, co-president of CanSupport, outlines that “since the pandemic, missed detection opportunities may result in patients being diagnosed with more advanced and harder-to-treat stages of cancer in the future. A Lancet study estimates that there may be an increase in cancer deaths as a result of diagnostic delays over the next five years, ranging from 4.8 percent for lung cancer to 16.6 percent for colorectal cancer [both among the most common forms of cancers among Indian men and lung cancer being one of the most common among women].” 

https://upload.wikimedia.org/wikipedia/commons/5/59/Breast_Cancer_Awareness_Programme_-_Nisana_Foundation_-_Unsani_-_Howrah_2013-12-22_5520-5522.JPG
A session aimed at raising breast cancer awareness. Image credit: Biswarup Ganguly [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)]

The pandemic may have exacerbated the issues surrounding cancer care and diagnostics in India, but it did not create them. World Cancer Day 2021 assumes heightened importance. Its official website opines that “2021 – the ultimate year of the ‘I Am and I Will’ campaign – shows us that our actions have an impact on everyone around us, within our neighbourhoods, communities and cities. And that more than ever, our actions are also being felt across borders and oceans. This year is a reminder of the enduring power of cooperation and collective action. When we choose to come together, we can achieve what we all wish for: a healthier, brighter world without cancer. Together, all of our actions matter.” 

This is indeed an apt sentiment. India does have some progressions to tout, such as efforts to mitigate the damage of risk factors for developing certain forms of cancer such as its efforts against tobacco and malnutrition via the Eat Right India campaign. Expansion of telemedicine programmes is another means of plugging the cancer care gap, making screening more accessible. The Government’s inclusion of a number of crucial oncology packages in health insurance scheme Ayushman Bharat is also a positive. 

However, there are gaps in similar efforts too. Delaying national rollout of the human papillomavirus vaccine to fight against cervical cancer being among the most egregious. Meanwhile, many people eligible to avail ostensibly free oncology care drop out for want of resources. 

As Gupta notes, “What we also know is that underserved populations everywhere are at greater risk of dying of diseases like cancer due to limited access to detection facilities and to advances in cancer treatment that they simply cannot afford. Consequently, they are more likely to die of cancer.”

Fighting cancer in India is integral to the country’s socioeconomic development; to strengthening its communities; and meeting the Sustainable Development Goals. To do this, addressing the socioeconomic inequalities plaguing India’s health system on all fronts is vital.

Source: https://www.healthissuesindia.com/2021/02/04/cancer-in-india-a-snapshot-of-the-threat/

Covid19

A Federal Judge Blocks A Vaccine Mandate For NYC Teachers

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A student arrives for the first day of class at Brooklyn’s PS 245 elementary school in New York on Sept. 13. Mark Lennihan/AP hide caption

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Mark Lennihan/AP

NEW YORK — New York City schools have been temporarily blocked from enforcing a vaccine mandate for teachers and other workers by a federal appeals judge just days before it was to take effect.

The worker mandate for the nation’s largest school system was set to go into effect Monday. But late Friday, a judge for the 2nd U.S. Circuit Court of Appeals granted a temporary injunction and referred the case to a three-judge panel on an expedited basis.

Department of Education spokesperson Danielle Filson said officials are seeking a speedy resolution by the circuit court next week.

“We’re confident our vaccine mandate will continue to be upheld once all the facts have been presented, because that is the level of protection our students and staff deserve,” Filson said in an email.

She said more than 82% of department employees have been vaccinated.

While most school workers have been vaccinated, unions representing New York City principals and teachers warned that could still leave the 1 million student school system short of as many as 10,000 teachers, along with other staffers, such as cafeteria workers and school police officers.

New York City Mayor Bill de Blasio has resisted calls to delay the mandate.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/09/25/1040699321/nyc-teachers-vaccine-mandate-judge-blocks-schools

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Limits On Toilet Paper And Cleaning Supplies Are Back At Costco

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Shoppers lined up to buy supplies at Costco Wholesale in New Jersey last year as fears over COVID-19 grew around the world. The company recently reintroduced limits on toilet paper, cleaning supplies and other products as it copes with supply chain challenges. Anadolu Agency/Anadolu Agency via Getty Images hide caption

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Anadolu Agency/Anadolu Agency via Getty Images

The days of toilet paper shortages may not be over just yet: Costco has announced new limits on purchases of certain household items, as supply chain issues bedevil the company and the delta variant spreads.

The company is putting “limitations on key items” such as toilet paper, bottled water and cleaning supplies so it can meet any uptick in demand due to the COVID-19 surge, Costco Chief Financial Officer Richard Galanti said during the company’s latest earnings call on Thursday.

He did not specify how many items customers would be allowed to buy.

“A year ago there was a shortage of merchandise,” Galanti told investors during the call.

Now, Galanti said the retailer has plenty of merchandise, but delivery delays are the issue, citing “short-term changes to trucking” and “delivery need” as the main factors.

In the meantime, Galanti said Costco is trying to stay ahead of the curve by continuing to placing orders early to get stores what they need.

In an effort to address the delivery issues, Galanti told investors that the company has chartered three ocean vessels for the next year to transport several thousand containers between the U.S., Asia and Canada. Each ship will be able to carry 800 to 1,000 containers at a time.

The membership-only warehouse retailer said it has seen an increase in overall price inflation on its products this quarter, estimated to be between 3.5% and 4.5%, Galanti said.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/09/24/1040471872/limits-toilet-paper-cleaning-supplies-costco-delta-covid

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A CDC Panel Backs Booster Shots For Older Adults, A Step Toward Making Them Available

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A CDC advisory panel has recommended a third Pfizer-BioNTech COVID-19 vaccine dose for those who are 65 or older or run a high risk of severe disease. Matt Rourke/AP hide caption

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Matt Rourke/AP

Advisers to the Centers for Disease Control and Prevention have recommended a third dose of Pfizer’s COVID-19 vaccine for people 65 and older as well as others at a high risk of severe illness.

The committee’s unanimous vote to allow older adults and long-term care residents to receive an extra dose of the Pfizer-BioNTech vaccine was announced after two days of presentations reviewing scientific evidence on the safety and effectiveness of a third vaccine dose.

The committee, in a 13-2 vote, also recommended that people 50 to 64 years old with underlying medical conditions get a third shot.

It also endorsed people ages 18 to 49 who have an underlying medical risk access to another dose. The panel split 9-6 on this point but settled on advising that these people consider their individual benefit and risk, possibly in consultation with a medical provider, before they get a Pfizer booster shot.

In what might’ve been the most contentious deliberation, the committee said people 18 to 65 who work in a job or other setting where they are at high risk of exposure to COVID-19 should not yet be allowed to receive an extra Pfizer dose.

Committee member Dr. Matthew Zahn, a pediatric infectious diseases specialist, expressed concern about the difficulty of implementing such an action. Another member, Institute for Health Research investigator Dr. Matthew Daley, said he was worried that the potential guidance would be “broad enough that it could limit access to other groups.”

The CDC has yet to offer guidance on the use of COVID-19 boosters for fully vaccinated Americans. The influential federal public health agency usually follows the advice of its advisory committees although it’s not required to do so.

The recommendation follows the Food and Drug Administration’s authorization on Wednesday to offer a booster shot for people 65 and older and those who run a high risk of severe disease. The FDA also gave the OK to give people a booster to ages 18 and up whose exposure to the coronavirus puts them at high risk of serious complications from COVID-19.

Vaccine providers must follow the CDC’s recommendation

The CDC recommendations, when issued, are crucial at this phase in the pandemic. As cases surge across the country, the booster guidelines will determine how widely doctors and other health care workers administer those vaccine doses.

Dr. Sara Oliver, a CDC scientist, stressed at Thursday’s advisory meeting that because the federal government has purchased all of the COVID-19 vaccines on an emergency basis for the pandemic, including the Pfizer vaccine, vaccine providers are required to follow the recommendations of the CDC and the FDA.

CDC and FDA recommendations will inform Biden’s booster plan

The FDA authorization also allows the Pfizer booster dose to go to health care workers, teachers, grocery workers and those in homeless shelters or prisons, Dr. Janet Woodcock, the agency’s acting commissioner, said in a statement.

U.S. regulators will rule on booster guidance for those who have gotten the Moderna or Johnson & Johnson vaccine at a later date, The Associated Press reported. Moderna’s two-shot vaccine and Johnson & Johnson’s one-shot vaccine are currently offered under an emergency use authorization, pending formal FDA approval.

Like the FDA, the CDC panel’s decision breaks with the Biden administration’s sweeping booster strategy to offer an extra dose to most age groups as early as this week in an effort to protect Americans against the highly contagious delta variant.

But the White House said that Biden’s booster rollout, laid out last month, would also continue to heed the guidance of government scientists as it awaited both FDA authorization and CDC guidance on COVID-19 vaccine boosters.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/09/23/1040078971/cdc-covid-19-pfizer-boosters-adults-guidance

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Florida Makes Quarantine Optional For Students Exposed To COVID-19

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Florida Gov. Ron DeSantis, seen at a news conference last week. His newly appointed surgeon general on Wednesday signed protocols allowing parents to decide whether their children should quarantine or stay in school if they are asymptomatic after being exposed to someone who has tested positive for COVID-19. Wilfredo Lee/AP hide caption

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Wilfredo Lee/AP

ORLANDO, Fla. — A day after assuming his job, Florida’s newly appointed surgeon general on Wednesday signed new protocols allowing parents to decide whether their children should quarantine or stay in school if they are asymptomatic after being exposed to someone who has tested positive for COVID-19.

The new guidelines signed by Dr. Joseph Ladapo also tweaked the state’s prohibition against school mask mandates, prompting an administrative law judge to dismiss a lawsuit against the old rule that had been filed by various school boards.

In terms of quarantine rules, Ladapo eliminated previous mandates requiring students to quarantine for at least four days off-campus if they’ve been exposed. Under the new guidelines, students who have been exposed can continue going to campus, “without restrictions or disparate treatment,” provided they are asymptomatic. They can also quarantine, but no longer than seven days, provided they do not get sick.

“Quarantining healthy students is incredibly damaging for their educational advancement,” Republican Gov. Ron DeSantis said Wednesday at a news conference in Kissimmee. “It’s also disruptive for families. We are going to be following a symptoms-based approach.”

The U.S. Centers for Disease Control and Prevention says people who get infected can spread the virus starting from two days before they have any symptoms. The CDC recommends that a student should quarantine for 14 days if they are unvaccinated. They can shorten the quarantine to seven days by testing negative, according to the CDC.

The president of a statewide teachers’ union said school districts need all the tools necessary to keep children safe.

“Limiting districts’ options and blocking them from following CDC guidelines is not in the best interest of the health of our students, employees or families,” said Andrew Spar, president of the Florida Education Association.

DeSantis named Ladapo to the job on Tuesday. Ladapo, who previously was a UCLA doctor and health policy researcher, shares the governor’s approach to managing the coronavirus pandemic. Like DeSantis, Ladapo has said he doesn’t believe in school closures, lockdowns or vaccine mandates.

DeSantis’ administration has opposed mask and vaccine mandates, fought local school boards over their efforts to require students to wear masks in schools and championed the use of monoclonal antibodies as a treatment for those who get sick with COVID-19.

Unchanged from the earlier rules are requirements that students with the virus either quarantine for 10 days, receive a negative test and be asymptomatic before returning to campus or offer a doctor’s note granting permission.

As in the previous guidelines, schools can require masks as long as students can opt out, though the new rules add language that it’s “at the parent or legal guardian’s sole discretion.”

School officials in Alachua, Broward, Leon and Miami-Dade and Orange counties recently challenged the state’s prohibition against mask mandates. But the Florida Department of Health argued that its new rule should lead to the dismissal of the lawsuit that targeted the old rule. An administrative law judge agreed Wednesday, saying no decision on the validity of the rule could be made since it had been repealed.

Alachua County Public Schools Superintendent Dr. Carlee Simon called the Department of Health rule changes “disingenuous.”

“Essentially, the State is responding to the legal challenges of its rules by repealing them and creating new ones, with limited public notice,” Simon said in a statement.

PlatoAi. Web3 Reimagined. Data Intelligence Amplified.
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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/09/22/1039907024/florida-quarantine-optional-for-students-exposed-covid

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