Three young people have died in Kerala in 8 months from food poisoning, linked with consuming “Arabic” style grilled chicken served with baked rice, locally made mayonnaise and salad.
Devananda was only 16. The new year saw the deaths of Reshmi, 33 and Anjusree, 19.
Thread 👇
Discussed this at @manoramanews Counterpoint, linking my discussion. More in my article below. Will link the news articles too👇
Locally made “shawarma” consists of a large conical block of meat (chicken) assembled elsewhere and brought to the site of delivery. It can be 2-3 feet tall, 1 foot wide, slow cooked by a heat source behind it, which means there is partially cooked meat deeper within.
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The meat gets shaved off from its outer (hot) surface, and served as a wrap along with salad and mayo made from raw eggs, garlic and oil.
If the meat is already contaminated at assembly, this is an excellent culture medium for bacteria, especially the uncooked part.
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As the meat is assembled off site, there is no way for the customer to tell if it was done in hygienic conditions, or kept overnight after slow sales the previous day.
For customers who are traveling, it is not easy to check the reputation of the restaurant.
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Although food safety inspections occur periodically, the recent mushrooming of these types of roadside eateries appears to have overwhelmed their supervision capacity.
No deaths have been reported from other cuisines, which makes uncooked meat a prime suspect.
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There is no other type of food sold in Kerala that involves uncooked meat.
One other problem is the customer places an online order and consumes the product after a delay of several hours, enough for exponential multiplication of any harmful bacteria within.
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I do not believe the type of food is unsafe, as long as it is made and consumed in a safe manner.
But there are so many points where the chain can break.
1. Meat source 2. Delivery of meat to assembly point 3. Hygiene of assembly area 4. Hand-washing of staff 5. Storage
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6. How it is handled at the delivery point 7. How leftovers are treated 8. Whether sufficient time is given to cook before serving (eg. getting a large order could mean shaving deeper into the meat block, exposing uncooked meat) 9. Salads could be cut using the same knife
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10. Salads could be kept open and contaminated by visiting flies 11. Water may be contaminated 12. Mayonnaise made from raw eggs prone to contamination from dirt on egg shells (eggs seldom washed before cracking) 13. Delivery could be delayed, which gives time for bacteria
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14. Customer might not eat immediately, which means further multiplication of bacteria is already contaminated.
15. Customer might not keep in refrigerator, note 4-60 degrees centigrade is “danger zone”, allowing bacteria to grow rapidly.
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Supervision, training and quality control could be inadequate at multiple levels, a situation made worse by attrition of staff (restaurant workers are known to move frequently, hence training needs to be continuous process)
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From a consumer’s standpoint, the following would be some of my custom advice.
1. Stick to places that are known for safety and hygiene 2. Look beyond the dining area, especially at the surroundings - for clues to what’s cooking inside. 3. Open kitchens are cleaner
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4. Are the staff washing hands? 5. Trust our instinct or sixth sense, acquired by years of experience in such regions 6. Carry own water or at least buy bottled (not foolproof) 7. Avoid salads unless at a place of high standard 8. Do not delay consumption
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9. Check for valid FSSAI license on display. If they give you grief, give the place a miss - and report them.
10. Do not delay medical treatment if you fall sick after a meal. Early treatment can be lifesaving - even for young and robust people.
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Update on Anjusree’s case. Additional factors could be involved, say police. DMO had earlier said she died of multi-organ failure from septicaemia or bacterial infection entering bloodstream. Several family members who ate the same food had fallen sick.
1. SARS-CoV2 virus 🦠 enters cells in the nose through hair-like projections called cilia (pink)
2. It then hijacks the cell machinery to massively enlarge and branch the microvilli (blue)
3. Virus spreads to nearby ciliated cells.
See👇
Note this virus does not directly infect goblet or basal cells, which are the other cell types in the nasal lining.
Ciliated epithelial cells comprise 80% of nasal epithelium, each expressing about 300 cilia that dance continuously, propelling mucus in one direction.
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Cilia are hair-like structures that can reach above the mucus layer that’s normally impenetrable to the virus, like a lotus leaf projecting above the water. (Pic from our terrace garden)
Virus attaches on this, enters the cell without touching the mucus (that would kill it)
Low COVID caseloads continuing as we reported earlier
Very few of the tests are turning positive in hospitals
No ICU patients with COVID except an occasional incidentally positive patient with comorbidity
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Special guest @vinodscaria gave the following messages
1. Virus continues to evolve, difficult to predict trajectory 2. XBB has grown in India over the past several months, but is not causing significant clinical burden yet 3. A wave results from a combination of factors
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eg. susceptibility, environment, human behaviour/movement/travel, large events, exposure level, NPI compliance, vaccination status, duration since last immune exposure, variants etc.
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Overweight/obese individuals with COVID-19 who received a 2 week course of metformin were less likely to receive a Long COVID diagnosis later on. This was a secondary endpoint.
Results of this trial had previously been published, showing no difference in primary endpoint.
This is not the first time metformin is being used in COVID-19.
This trial specifically included people who were either obese or overweight, who might have benefited from metformin in other ways. For instance, a reduction in insulin resistance.
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The NIH COVID treatment guideline, does not recommend using metformin for Covid-19.
See link👇 for prior results, including the Brazil study that was halted after metformin arm showed more serious outcomes. (The current study reports the opposite)
Immunology of Long COVID explained by Prof. Iwasaki
Seen more:
1. Exhausted T cells (CD4 & CD8) 2. Activated B cells 3. Anti EBV 4. Anti Spike antibodies, low neutralising
Seen less:
1. Cortisol 2. CD4 central memory cells
Unchanged:
Autoantibodies
👆Lecture by Prof. Akiko Iwasaki @VirusesImmunity throws light into the immunology of long Covid by comparing them with healthy controls.
She describes a clear pattern that’s consistent with a prolonged and misdirected immune response, the cause of which is unknown.
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Re. EBV, there is no difference between the two groups in seroprevalence (that is, Long COVID is not because of EBV infection) but the antibody response to EBV was higher in the Long COVID group. The LC group also made more anti spike antibodies but were poorly neutralising.
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