CORONAVIRUS COVID-19 (SARS-CoV-2)
Dr. T. Rama Prasad
CORONAVIRUS -- COVID-19 ... September 1, 2020
( SARS-CoV-2 )
"Panicky over-reaction to corona deaths has destroyed global economy;
Strict implementation of 'hygiene advisory' would have been sufficient."
"Panicky over-reaction to corona deaths has destroyed global economy;
Strict implementation of 'hygiene advisory' would have been sufficient."
-- T. Rama Prasad
Life is like a prepaid card paid by the Creator. We don't know how much was paid and how much is in balance. Insurers are now stunned to know that COVID-19 can bring the balance down to zero within hours or days of its attack.
The British Prime Minister's card balance dropped suddenly to almost zero before he came out of the Covid ICU, days before a son was born to his fiancee !
'Covid Umbrella' -- a must 'Dog mask' -- a must
Is the “LOCKDOWN MEDICINE” too toxic ?
The subject of 'Lockdown' is an epidemiological hot potato. Is 'lockdown' right or wrong ? Both ! Hubris is toxic which conjures up pitfalls for all of us. Puffed up with exuberant hubris, we humans have committed two blunders simultaneously :
(1) We acted like the 'virus deniers' and ostriches (the Brazilian President Jair Bolsonaro, the British Prime Minister Boris Johnson and the US President Donald Trump), didn't care for the advisory and left our own fate to the destiny.
(2) We imposed 'Total Lockdowns' which could not be implemented as they should be and left the fate of the citizens to the destiny. In many countries, the delusive idea of lockdowns rested on a parade of fallacies and follies, and the people didn’t care for the hygiene advisory on prevention.
Considering the complex nature of the virus, we shouldn't let our guards down and simply surrender to the destiny. There is no uniform default strategy for all the countries and we have to make course corrections nimbly to maintain a balance between economic and public health costs and benefits. It is like being on a Schrodinger's seesaw. For instance, Sweden didn't lose much (lives, freedom & economy) despite not imposing tough lockdowns, perhaps because of voluntarily adhering to health advisory and the sense of social responsibility. And lowest mortality rates are logged in by Japan and South Korea without resorting to lockdowns, perhaps due to their culture of mask-wearing. India is different. It is a large country with different zones having different timelines of onset of the epidemic. Added to this is the notoriously poor compliance with guidelines by the 'bemused-cum-resigned' Indians. This means that a total lockdown of the whole country would not yield the desired result. More over, lockdowns have no 'historical scientific basis'. Eight months into the pandemic, it still remains an enigma. Cases surging further. Economy dipping lower. The number of cases has increased from 500 to over three million and the number of deaths has increased from 10 to over 64,000 in five moths after the 'lockdown'. Economy ? GOK.
The Corona Conundrum
“Doctor, is the lockdown good or bad for us ?,” asked Vinodini. I said, “both good and bad, like the Schrodinger’s cat which is both alive and dead.” The Nobel Laureate Erwin Schrodinger devised the famous ‘thought experiment’ of putting a cat and some lethal things inside a box to see whether the cat would be alive or dead in order to prove a point in quantum physics. Until one opens the box, the cat is supposed to be both alive and dead ! Same is the case with the lockdowns.
NOT A PLAGUE
The life of the first half of 2020 was like looking at scoreboards and listening to continuous commentary over media as of cricket or election results. The "case" score went on spiralling up. Erroneously, people have come to think that the "cases" are "patients suffering from COVID-19 requiring admission or quarantine." And that they are "dangerous and untouchables" though there is nothing to be alarmed or ashamed about it.
The people are more scared of the quarantine and the social stigma rather than the virus. The fact is that the virus is detected in their bodies, and that about 80% of them may not have any symptoms or only mild symptoms which may not require any specific treatment. We all have thousands of microbes in our bodies which may not produce disease because of our immunity. And, in course of time, we may gain immunity, called ‘herd immunity’, to this coronavirus also, through natural sub-clinical infections or vaccine when it is made. The Delhi sero-survey findings published in July 2020 indicate that a whopping 50 lakh people have already developed 'herd immunity' through 'silent infection', while only 100,000 cases (1 in 50 of the infected) were detected through RT-PCR testing, in Delhi of a population of 20 million. Later in August 2020, a new jaw-dropping sero-survey result followed – 57% positivity in Mumbai slums and 51% in some areas in Pune. Perhaps, because of better ‘India-specific’ racial immunity passed on through generations of cellular immunity and 'pre-existing' 'cross-reactive' ‘memory T cells’ against spike or membrane proteins of SARS-CoV-2, the ‘Case Fatality Ratio’ has been less than 2% in India, despite the creaky, rickety and shambolic health care systems. This is a sliver of a silver lining to our dark cloud.
THREAT PERCEPTION
The alarmist predictions on ‘Covid’ proved wrong. On a larger canvas, the damage done by the virus does not seem to be huge, especially in India. Less than 65,000 people died so far in India, as on 01.09.2020, due to COVID-19. It is a small number compared to 4,35,000 deaths due to TB annually or 1,50,000 deaths due to road accidents per year, in the country. How about deaths due to other diseases ? Too many. Ten million Indians die every year of various causes – an international disgrace. Just look at the figures for the lockdown period of 6 weeks (March 25 to May 5) -- India's pro-rated death toll from all causes would be 10 lakhs, including due to -- influenza and pneumonia of 75,000, TB of 54,000, diarrhoea of 50,000, road accidents of 32,000 and suicides of 24,000. The media have set the eyes of the whole country on only one coronavirus death out of 638 total deaths ! We had been kept in the dark about the other 637 'non-covid' deaths !
Lockdown, a blunt instrument, has become the default strategy and an epidemiological fashion, based on mathematical models of a limited theoretical frame. An indefinite transnational blanket ban of all activities just to tame one disease in a country like India is an example of profound insanity. Further lockdowns may further vitiate a nebulous situation. Can we lockdown for another two years ? During a press briefing in Geneva on August 21, 2020, Dr. Tedros, the head of the WHO said: "We hope to finish this pandemic in less than TWO YEARS, especially if we can pool our efforts."
Instead of using the 'sledgehammer of lockdown' to crack the 'nut of virus', strict enforcement of the troika of masks, distancing and hygiene, along with prompt 'testing', 'tracing' and 'treating' would have been sufficient for India. Improving the creaky health structure of 1.3% of GDP is imperative. Of course, we can’t fix decades of neglect while in the throes of a pandemic.
LEARN TO LIVE WITH IT
The only thing we are worried is about the speed with which this virus killed around the world and the mysterious pathology involved. But even then, the number of the COVID-19 deaths is nothing when compared to the deaths that occur routinely due to other diseases. At least 1,000 people have been dying every day in India due to TB alone over decades. Did we 'lockdown' the country ? We learned to live with it and we have to do the same with Corona. Perhaps, additionally, we have to learn to die in 'cytokine storms' ! "Learn to live and die with Corona" is far better than "Learn to live and die with Lockdown."
Mathematical models are different from ground realities. The cavalier calculations remained a mirage – where is that time-table of ‘peak’, 'flattening', ‘decline’ or ’community spread’ ? The scientific hubris backfired -- cases increased from around 500 to around three million and the deaths from around 10 to around 65,000, after the lockdown in just about five months, in India. Virtues of a martinet governance have been an illusion. Governmental obfuscation which took on mythic proportions and infected policymaking, is a matter of concern. It is highly complex -- it's not like switching-on and switching-off a light. With just an order everything can be locked down, but can't be opened the same way.
TUBE VISION
During the corona period we have cultivated a 'tube vision' which lets us see only about corona, blind to other diseases, hunger, deprivation, present and future livelihood, future GDP, etc. And, the 64 million city-slum-dwellers and the scores of migrant labour were outside the field of vision when the surgical strike of the lockdown was a 'breaking news'. Or was it a 'braking news' ? Millions of people were adversely affected due to break in vaccination schedules and unavailability of services for 'non-covid' ailments, because of the restrictions imposed by lockdowns.
Of course, one may argue that the scenario could have been worse, without the lockdowns -- a conjecture and a presumption. The pandemic-lashed reality intrigued both scientists and soothsayers alike.
RECALIBRATE THE STRATEGY
Nevertheless, lockdown is a very effective preventive medicine but is too toxic for India where it cannot be implemented as it should be on a national scale. Nonetheless, localised lockdowns (cluster restrictions) are necessary. Lockdown is just one of the tools, not a silver bullet. Not even the vaccine that may be coming. Going forward, a recalibration of the strategy is imperative. And only people-friendly strategies would work.
In India, stringent implementation of ‘Covid-preventive protocols (masks, distancing, hygiene, etc.)’, strict restriction of risk-prone activities in selected locations and PERFECT cost-free treatment of all the patients at any cost to save lives, and rendering all possible service at the PEOPLE'S DOORSTEP would yield better results than by imposing 'total lockdowns' and repressive police-powered restriction of movement of people. It should be a PEOPLE-FRIENDLY activity devoid of social stigma. No need to beat the poor and hungry migrant workers for the 'fault' of walking back to their homes across the States. No severe injuries due to thrashing for the fault of not wearing face masks. No fatal tortures for closing the shop late by one hour. No assaults on frontline-workers and doctors. All this happened – did it not ? It should be a 'containment' activity, not a 'lockdown' activity. There is a lot of difference between the two.
An enormous number of 'Mobile Medical Units' should go around all the living places continuously. These "Units" should go to the doorsteps, educate people about preventive steps, test them, trace the contacts, treat them at home on a daily visit basis, take them to hospitals when institutional treatment is needed (only about 10% need it), help them empathetically, drop them back at home after discharging and follow them up daily later. The holy grail should be 'at-home care'.
HOLISTIC APPROACH
They should also take care of the people's non-covid ailments during this interim period. Scores of people suffered and died due to the lockdown-related difficulty to access hospitals for 'non-covid' illnesses. For various reasons, many private doctors and hospitals shut their doors at this point of time when they could have played a pivotal role. A total 'touch-me-not' attitude prevailed, while the dire need was a total and friendly service. The service was distant at the mercy of the officials. If the help was at their doorsteps, people would have gained confidence, cooperated and even helped the authorities. They wouldn't have got scared, evaded to report symptoms and went underground breeding the virus and disseminating, scared of quarantines, as it had been happening -- this is one important cause for the surge of the cases.
‘Beds’ don't save patients. 'Quarantine prisons' won't halt the march. ‘Tests’ can’t cure. We relied too much on these. It is the “friendly human touch" that's important to persuade people to participate. They need not scramble here and there like headless chicken to finally get only a piecemeal type of impersonal response. All this had robbed TRUST and frustrated the people. People lost FAITH in the system and the science itself. We should not waste precious time waiting for the people to come for treatment. They won't come in the present panic-filled scenario unless trust is built up urgently. A delay in disease detection would lead to a cascade of events which negatively impact everything, from a deluge of patients to tragic fatalities. It’s all about using the right tools at the right time in a given situation. I repeat: The holy grail should be 'at-home care'.
A MARATHON, NOT A SPRINT
In this plan of action, there won't be many defaults. There won't be confrontations with officials and disregard to their protocols. Of course, an enormous number of vehicles and dedicated manpower is to be inducted. The cost involved and the loss of life (including that indirectly due to the lockdown) by doing it this way would be phenomenally much less than what it could have been with a 'total lockdown'. This is a homely holistic solution. It is the 'coronaphobia' and the 'lockdown-overreaction' that killed everything. Governments cannot be blamed for all this because they are mostly guided by their scientific and bureaucratic advisors, rightly or wrongly." But the bewildering fact is that the hard-hitting ‘Joint Task Force’ official statement issued by Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and Indian Association of Epidemiologists (IAE) bluntly blamed the government for relying more on the bureaucrats than on experts in the field1. The statement pointed out several lapses by the government and made many recommendations to replace what they called "draconian lockdown."
Now that It's clear that the fight is a marathon and not a sprint, the need is for endurance, perseverance and patience, at least until we get a vaccine. Vaccine-making is another mindless hasty activity like the 'lock down'. See the speedy 'Russian roulette' of 'Sputnik V' which set aside scientific norms and pursued 'vaccine nationalism'. If this vaccine fails, it may generate mutants more hazardous than D614G.
Vinodini looked a bit beyond and said that the surge to seek therapy from shrinks would also shrink by this holy grail of 'at-home care'. In India, 7.5% of the population suffers from mental disorders, according to the WHO. And It is estimated that the ‘lockdown-stress’ would increase this illness by 20%.
Dr. T. Rama Prasad
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre, Perundurai, Tamil Nadu, India.
Presently: Director, PAY WHAT YOU CAN Clinic, Perundurai, Erode District, Tamil Nadu – 638052.
Reference:
This is what I said at a WEBINAR.
For more about the LOCKDOWNS, read under the subheading "THE LOCKDOWN CONUNDRUM" further below.
=============================================================
The following is the comment written by the internationally renowned scholar, Pritam Bhattacharyya (Editor-at-Large of Pentasect and Founder and Chief of Wordsmith at Wordsmith Communication, Chairman of Freelance Foundation, ) on this blog article (Coronavirus COVID-19 (SARS-CoV-2) -- (1) https://wordsmithofbengal.wordpress.com/2012/01/16/health-un-heath-and-fear-of-un-health/
(2) https://wordsmithofbengal.wordpress.com/2012/04/23/google-effect-and-kali-yuga-prophecies/ One of the best articles I have read on this theme and having balance, measure and proportion. Miss Corona in hindsight is really kind and benign in a sense - Nature has rolled a dice with fatality of 2-3%. She is under no obligation not to roll a dice of fatality 40,50,60% with Mr. Corona being "size zero" and "air-borne". Consider what would have happened ?
Dr. Prasad is one of the few doctors whom I know who fall into the rare category of "healers". A healer knows the art, science and commerce of healing, i.e. allowing the innate immunity of the body to manifest itself.
One should be very careful and critical about three things in the world : Big Pharma, Big Government, Big Science. In the proverbial Kali-Yuga, all three converge with overlapped agendas and sometimes not with the best interest in mind of the end users : patients, citizens, learners.
Finally, this pandemic will also pass. The system will come to a new equilibrium. But I think a whole generation will carry this impression forward and may become saner with this.
I nurture another hope : just like pivotal events propel a whole generation (Apollo Mission and interest in space science), this may inspire many young Indians to shift their focus into public healthcare, virology, immunology, public immunity, psychological counseling and learning the art and science of healing.
Again, it was very nice to find an article of this time in the avalanche of printed words in this theme.
Continue your good work.===========================================================
September 1, 2020: UNLOCKED. No, we are not scared Miss CORONA. We have decided to live with you because "LEARN TO LIVE AND DIE WITH CORONA" is better than "LEARN TO LIVE AND DIE WITH LOCKDOWN". Let us have a HAPPY LIFE TOGETHER. -- Dr. T. Rama Prasad, PAY WHAT YOU CAN Clinic, Perundurai.
CHARLES ROBERT DARWIN
Westminster Abbey, LONDON June 21, 2020
Dear Humankind,
Once again, read what I wrote above. SARS-CoV-2 is 'most adaptable to change'. That's why it is surviving and thriving. That's the secret of success of some species. Some of you might have read my writings on "Origin of Species", "Theory of Evolution", "Natural Elimination of the Weakest", "Survival of the Fittest", etc. You, Humans, are still on earth because of your adaptability. But now you are not able to cope up with Corona. When you can't conquer Corona, you have to adapt rather than to surrender.
It's a pathetic sight to see you all scramble over like a headless chicken and finally locking yourselves inside your homes with absolute uncertainty of coming out. How long are you going to lockdown your means for livelihood and still be alive ?
This novel Corona is a story about 'Much ado about nothing'. OK, it's about 'Much ado about something', because it spread faster, killed quickly and affected many, a bit unlike the previous coronaviruses and pandemics. But it need not cause panic. It is a fitting solution for the overpopulation and indiscipline, and an action of nature in tune with happenings for healthy sustenance of species.
You had 'super-evolved' to manipulate 'Nature' to suit your self-centred materialistic interests. You had altered the course of evolution and invited calamities like droughts, floods, forest fires, earthquakes, tsunamis, formidable diseases, both metabolic and infective, etc. And now you invited Coronavirus. It will be your permanent guest. Nature has its own ways of controlling ecosystems and maintaining environmental balance. Don't interfere with it too much. Adapt, adapt and adapt.
When you go beyond a limit, nature steps in for a speedy correction of the course of evolution which in normal course takes a very long and sinuous course. The speedy correction is needed in your own interest, to upgrade species and provide them better evolutionary opportunities and perfections. That's why Corona stepped in. Let it do its job, while you protect yourselves and treat yourselves to the possible extent. But don't go overboard.
The idea of nature is to relieve the hopelessly sick, weak and unproductive, and to endow the rest of the over-populated lot with better living conditions, and to promote more robust genetic pool of human species. You are nearly eight billion and nine per cent of you are aged 65 or over. You were half of this number half-a-century ago. It is the evolutionary necessity to get rid of the dead wood (some of the aged and the chronically ill who are hopelessly vulnerable to serious illnesses and who may soon succumb even without COVID-19) which is more of a liability, health wise and economy wise, at present and in future. Corona may take away some of these people 'naturally'.
In the large context of species preservation, there is not much place for sentiments. This doesn't mean that all the vulnerable would be or should be wiped out -- those with good immunity and who take extra care would escape. And who knows ? The number of these 'natural covid' deaths may be much lesser than the deaths due to your interventions -- and think about the enormous deaths that may occur indirectly for various reasons due to consequences of lockdowns.
This is my recognised theme of ecosystems -- 'Natural elimination of the weakest and survival of the fittest'. What doesn't kill you , makes you stronger, and more immune. Moreover, the virus would have taught you all human beings, by now, how to live a 'good lifestyle' and prevent future calamities, catastrophes and cataclysms.
What did you do when this corrective step by nature struck you ? You mortals interfered with nature again, too much. Didn't allow the virus to do its job. It couldn't 'peak' early, decline early and leave early, leaving you with some sort of 'herd immunity'. You delayed everything and upset your own whole set up. You 'locked down' everything and deployed all your ammunition to kill the enemy. Unmindful of your defences and offences the highly 'adaptable' enemy forayed into every nook and corner of the globe and tanked you all. The lockdowns didn't kill the raging virus, but they sure did kill millions of jobs.
Arrogance against nature. Albert Einstein said: "The only thing more dangerous than ignorance is arrogance." When arrogance failed, you went into a fit of fear out of which you went into a mode of "Lockdown." You have sent the whole economy into a tailspin, with jangled nerves and rattled lives, presaging difficult times ahead, and with uncertainty looming large. Your meticulously programmed career schedules, birthday bashes and holiday itineraries are kaput. Oh, how scared you humans are -- non-touch friendship, non-touch romance, non-touch weddings ... ! And all your big investments, backed by prudent actuarial consultants, went bankrupt. The highly ambitious launches of big business barons are going down the sunset. All these could have been avoided if you had sensibly handled the situation without hubris, and with adaptiveness and level-headedness. Industrial ecosystems can't be created by magic nor can they be revived by a silver bullet. You destroyed them, just as you destroyed forests out of your greed. Over the top reaction. Can you reforest by a click on your laptop ? Your greed has no limits and ethics at all -- even in the midst of the corona crisis, you indulged in murky profiteering activities through shameful and fraudulent research publications about anti-corona drugs in reputed journals like The Lancet and The New England Journal of Medicine. And you call it 'Modern Medicine' !
Through your stupid reaction, you thought that you saved a lot of lives, but it is insignificant when compared to the overall deaths, death of economy, sliding down of living standards, attrition, recession and severe slowdown over an indefinite period of future.
While taking some basic precautions and necessary treatment, if you had allowed the virus to do its job of "evolution" and allowed yourselves to do your jobs normally, some of the 'dead wood' would have perished, but the remaining lot would have been robust both health-wise and economy-wise. The fear now is that the whole lot may become "dead wood" in course of time for 'non-COVID-19' reasons. And I hate to write a book titled "The Extinction of Humankind."
Long live Homo sapiens !
Yours humanly,
CHARLES DARWIN
-------------------------------------------------------------------------
CHARLES DARWIN and GOD
 |
| Westminster abbey |
---------------------------------------------------------------------------------------------------------
This looks like a bomb, a corona and the planet Earth. Earth is of the size of 12,000 kilometres in diameter, a bomb about one foot and the virus about 0.125 microns. Why are we afraid of small things ? Should we use sledgehammers to crack nuts ? Use an axe to kill a mosquito ? In fact, could we kill mosquito which has been killing millions ? Shameful for our gigantic strides in science and technology! For over six months, the tiny virus generated a welter of information for us to talk non-stop about politics and pandemics to weather and Weltanschauung. With increased database on Covid, confusion has proportionally increased. Have we overcomplicated corona pandemic ? Yes, we would do pretty darn well by just sticking to the basics of prevention and treatment instead of confusing more with mutations like D614G.
MISSING STRANGERS !
People felt lonely during the lockdown. Not because they missed their near and dear. But because of missing the crowds of strangers -- in public places, roads, restaurants, shops, bus stops, markets, beaches, parks, temples, trains, buses, etc. Human psychology is such that they badly missed what they used to complain as a nuisance.
Imagine sitting alone in a movie theatre; travelling as a lone passenger in a train; shopping in an empty mall; navigating through an exhibition without people jostling around; being in a 'kalyanamandapam' with just a few known people -- this applies to both hosts and invitees !
And imagine the flow of 'strangers' in the stunningly colourful gardens of the 'Gardens by the Bay' or in the 'Jewel' at Singapore. They don't really enjoy without the presence of the strangers though they never interact with them, be it in Singapore or Srirangam.
They miss the din and noise generated by strangers. They miss the mad rush, traffic jams, the hustle and bustle of city life, speeding vehicles belching exhaust fumes, blaring cacophony of music and noise everywhere. All those bad things seem to make people happy. Yes, they missed them badly. Difficult to understand the human being !!!
THE TICKING TIME BOMB
Except for these speedy catastrophic events, most of us would not have even known the name of this disease.
This coronavirus could have been just another virus except for the following peculiarities:
(1) About 5% of the patients with mild symptoms suddenly ran into life-threatening emergencies. (2) Blood oxygen dropped too low without causing the usual warning of breathlessness, but killing the brain / heart fast -- 'happy hypoxia' -- even while 'happily' taking dinner or walking -- see the newspaper report below. (3) Lining of the blood vessels in the lungs and many other organs in the body were affected rapidly. (4) Extensive pneumonia was present without severe external symptoms. (5) Unexplainable clotting of blood occurred which quickly lead to death, even in young people. (6) Heavy casualties occurred in the most developed countries (about 4 million cases and more than 1,46,000 deaths -- a quarter of the global burden, as on 27.7.20, in the US which has the world's best healthcare infrastructure). (7) Exceptionally fast and wide spreading.
(1) About 5% of the patients with mild symptoms suddenly ran into life-threatening emergencies. (2) Blood oxygen dropped too low without causing the usual warning of breathlessness, but killing the brain / heart fast -- 'happy hypoxia' -- even while 'happily' taking dinner or walking -- see the newspaper report below. (3) Lining of the blood vessels in the lungs and many other organs in the body were affected rapidly. (4) Extensive pneumonia was present without severe external symptoms. (5) Unexplainable clotting of blood occurred which quickly lead to death, even in young people. (6) Heavy casualties occurred in the most developed countries (about 4 million cases and more than 1,46,000 deaths -- a quarter of the global burden, as on 27.7.20, in the US which has the world's best healthcare infrastructure). (7) Exceptionally fast and wide spreading.
Except for these speedy catastrophic events, most of us would not have even known the name of this disease.
This virus ruins our immune system (our Interferon proteins alert the body when enemy enters -- then our antibodies kill the enemy pathogen -- then our T-cells & B-cells eliminate our infected cells). Peculiarly, this virus cheats the system, gains entry into cells, rapidly destroys them even before the alert is sounded and the antibodies arrived. And it triggers a 'self-killing' over-reaction of our immune system ("cytokine storm") -- immune system going overdrive damaging our own organs fatally.
It is the ticking clock that has set the pace in 'corona matters' -- emergency to find a vaccine and cure, a race against time. In the absence of these in sight, amidst the doom and gloom of lockdowns, people have become panicked and been driven into utter confusion and paranoia. Quite a bit of this panic situation is due to media hype and disproportionate coverage. And this lead to overreaction by governments resulting in severely restricting movement and locking down everything which is quite uncalled for. This did more damage than good. After all, the Coronavirus didn't cause morbidity and mortality much more than what other microbes have already been doing. This is just a new speedy wave.
Until a vaccine or cure is found, it seems we are doomed to "Touch -me-Not".
"Touch-me-Not". Even the "Touch-me-Not" plant in the video above is saying "Namasthe" by folding its hands (leaves) instead of shaking hands !!!
Even the dog is scared of Covid !
CORONA TEMPLE
Uncertainties and vicissitudes in life often make one hobble through life with the help of the crutches of faith. During the past half-a-century, "true devotion" seemed to have become slightly faded, partly due to scientific advancements and arrogance of affluence. Now that the science couldn't certainly stop Corona and lockdowns, and that lockdowns are melting away affluence and arrogance, people are leaning more on faith for support. Alas ! Then the temples are closed. A new temple has come up as you can see below:
This is what 'CORONA DEVI' said:
Dear Humans,
YOU are now having time to reflect on what is important in your life.
When all this is over and I am gone ...
Shed your arrogance … grow compassion instead.
Listen to the earth
Stop Polluting the earth … Stop fighting amongst yourselves.
Stop caring about materialistic things
Start caring about the earth and all its creatures
Because, next time, I may come back even stronger and punish you more.
Helpfully yours,
Corona Devi.
"If you destroy NATURE, Miss Corona would wipe you out with NUCLEIC ACIDS, not NUCLEAR WEAPONS." -- T. Rama Prasad.
People are suspicious of everybody being a potential carrier of the virus. They can't do away with maids and they don't want to risk their coming in. They behave with them as though they are devils bringing in the virus. Be humane -- treat them with kindness, dignity and respect. After all, they have been cleaning our houses, cooking our food, washing our clothes, bringing up our children, etc. Read about the paranoia in the clipping below.
An estimated 67 million people are employed in domestic work around the world. Most of them are women. This is a vast but hidden force asserting their rights on the 'International Domestic Workers Day' on June 16.
------------------------------------------------------------------------------------------------------
STATISTICS
It's now amusing to read what I wrote on this blog page 5 months ago: "As on 24.01.2020 … The death toll has alarmingly increased to 26 in China. Korea, US, Taiwan, Hong Kong, Singapore & Vietnam also identified cases. The total number of cases reported has quickly rose to 834, ..."
We thought that 26 deaths was an 'alarming' number. Today, on August 1, 2020, one is dying every 15 seconds in the world !
August 1, 2020
World 17,351,647 cases 2,226 ca/1m 673,339 deaths 86 dts/1m
US 4,612,837 cases 13,930 ca/1m 154,766 deaths. 467 dts/1m
India 1,639,350 cases 1,187 ca/1m 35,789 deaths. 26 dts/1m
China. 84,165 cases. 58 ca/1m 4,634 deaths. 3 dts/1m
Singapore 51,809 cases. 8,850 ca/1m 27 deaths. 5 dts/1m
Tamil Nadu. 240,000 cases. 3,838 deaths
---------------------------------------------------------------------------------------------------------
INDIA
Before 'Lockdown' on 24.03.2020 564 cases 10 deaths
After 'Lockdown' on 01.07.2020 585,729 cases 17,410 deaths
01.08.2020 1,639,350 cases 35,789 deaths
01.09.2020 3,624,613 cases 64,646 deaths
Before the ‘lockdown’ on March 24, 2020, there were 564 ‘cases’ and 10 deaths in India. When it was ‘unlocked’ on June 1, 2020, there were 97,008 cases and 5,606 deaths. And, just after 30 days, on July 1, 2020 the number of cases had increased to 585,729 and the deaths had increased to 17,410. And look at the figures of August 1, 2020 !!! It looks that all the efforts of lockdown probably only delayed rather than averted the effect of the epidemic. At best, they were only partially-successful, especially by not allowing the fatality rate to go up enormously. When a ‘green zone’ is opened it is turning into a ‘red zone’ in no time.
India: 50,000 cases up to May 6th; In the next 27 days - increased to 200,000.
'Total Lockdown' from March 24 to May 31. In the next 27 days, it has
increased to over 500,000 ! On July 16, 2020, it was one million !!
And just after a couple of weeks, on August 1, 2020, it was more than
one-and-a-half million !!!
A KNOWN UNKNOWN
These are called DATA and STATISTICS -- a known unknown ! Using the same figures, different people draw different conclusions by twisting, torturing and tabulating to testify triumph or defeat. Data is the new corona oil, also the new snake oil. Punditry has it that what gets measured gets managed. Donald Trump says they tested more and recorded data more accurately, so they have more cases and more deaths. India says look at the data of per million, we have less cases, and very less deaths. Record keeping in India is a known unknown. To paraphrase Shakespeare, the Bard, in Julius Caesar, politicians have and will peddle snake oil, in the hope that people will willingly believe what they wish to be true.
“Lies, damned lies and statistics.”
-- Benzamin Disrael
--------------------------------------------------------------------------------------------------------------
C for CHILDREN
A - for apple. B - for boy. C - for China. Co - for Corona, COVID-19, Cold, Cough, Comorbidity, Corticosteroids, Covaxin, Covifor, Confusion, Conundrum. Any more for C ? Cytokine storm, Curfew, Containment zone, Cops, C vitamin, Chloroquine, Cholcicine, ChAdOx1nCoV-19 and finally Critical care, Cemetery & Cremation. 11,000,000 cases & 500,000 deaths !!! Oh, deadly "C" !!! -- T. Rama Prasad.
During the first four months of the "AC (After Corona) era", an impression was given that children were an exception to corona attack. As months rolled by more and more cases of children were being reported. Even a four-days-old baby who died was tested positive at GRH, Trichy (Aug 2, 2020), and 39 newborns tested positive at IOG, Egmore. And more than 3 lakh American children were infected.
Youngsters are so uncertain of their lifespan that they are running to their lawyers to execute a 'will' for their properties. See the newspaper clipping below:
And many are rushing for LIFE INSURANCE policies for HUGE AMOUNTS.
The 'Insurance Regulator' has made announcements regarding "COVID KAVACH" and "COVID RAKSHAK" health insurance schemes.
--------------------------------------------------------------------------------------------------------------------------
"Lockdown is a reserve drug to be used sparingly in selected cases which are resistant to safer drugs, in view of its long term serious side effects. It's not a panacea for all Covid ills." -- T. Rama Prasad
----------------------------------------------------------------------------------------------------------------------
"The most absurd expectation from a "lockdown" is that it is a totally effective eradicator of the virus. The truth is that it is the costliest medicine with a little effectiveness and a lot of serious side effects." -- T. Rama Prasad--------------------------------------------------------------------------------------------------------------------------
"We may be coming to the close of a 'lockdown' period. Let us not debate whether the lockdown did good or bad, as much can be said on either side. Leave alone the micromanaging controversies and try to see the larger picture and learn and unlearn quickly and prudently."
-------------------------------------------------------------------------------------------------------
"COVID-19 is our permanent guest. When it mutates into a less lethal strain, it would be just another guest like H1N1, AIDS, Dengue, Flu viruses, etcetera about which we don't bother so much. Finding -- T. Rama Prasad
-------------------------------------------------------------------------------------------------------
"If the mode of transmission is understood and the imperative preventive measures are strictly practised by the entire populations around the world, the disastrous economic destruction due to lockdowns could have been avoided. And the COVID-19 patients could have been treated according to the need without the terrifying mass quarantines of stupendous negative impacts."
-------------------------------------------------------------------------------------------------------
SYNDEMIC
When two or more epidemics interact synergistically to produce an increased burden of disease, we call it a 'syndemic'. The Asian Influenza Pandemic of 1957 killed not only by primary viral infection, but also by secondary bacterial infections. It was a viral/bacterial syndemic. Now, the COVID-19 can join hands with other microbes and cause further havoc.
https://www.thehindu.com/opinion/op-ed/preparing-for-a-syndemic/article31617304.ece
"The most absurd expectation from a "lockdown" is that it is a totally effective eradicator of the virus. The truth is that it is the costliest medicine with a little effectiveness and a lot of serious side effects." -- T. Rama Prasad--------------------------------------------------------------------------------------------------------------------------
"We may be coming to the close of a 'lockdown' period. Let us not debate whether the lockdown did good or bad, as much can be said on either side. Leave alone the micromanaging controversies and try to see the larger picture and learn and unlearn quickly and prudently."
-------------------------------------------------------------------------------------------------------
"COVID-19 is our permanent guest. When it mutates into a less lethal strain, it would be just another guest like H1N1, AIDS, Dengue, Flu viruses, etcetera about which we don't bother so much. Finding -- T. Rama Prasad
-------------------------------------------------------------------------------------------------------
"If the mode of transmission is understood and the imperative preventive measures are strictly practised by the entire populations around the world, the disastrous economic destruction due to lockdowns could have been avoided. And the COVID-19 patients could have been treated according to the need without the terrifying mass quarantines of stupendous negative impacts."
-------------------------------------------------------------------------------------------------------
"Clear understanding of the facts about this disease and voluntarily applying the knowledge goes a long way to prevent morbidity and mortality, rather than applying coercive and punitive measures."
--------------------------------------------------------------------------
"The greatest damage that this pandemic did and will do is of infusing FEAR into our blood through media. The 'INFODEMIC' is the real pandemic destroying health and economy through FEAR which leads to frightening thoughts and disastrous interventions." -- T. Rama Prasad
----------------------------------------------------------------------------------------------
"Let's not debate. This virus has come here as a permanent guest. Let's not be obsessive to eradicate it. Even if we lockdown for 3 years, it would be there, mutating continuously. We have to act in a smart and nimble way where responsibility is shared between government and society." -- T. Rama Prasad
----------------------------------------------------------------------------------------------
--------------------------------------------------------------------------
"The greatest damage that this pandemic did and will do is of infusing FEAR into our blood through media. The 'INFODEMIC' is the real pandemic destroying health and economy through FEAR which leads to frightening thoughts and disastrous interventions." -- T. Rama Prasad
----------------------------------------------------------------------------------------------
"Let's not debate. This virus has come here as a permanent guest. Let's not be obsessive to eradicate it. Even if we lockdown for 3 years, it would be there, mutating continuously. We have to act in a smart and nimble way where responsibility is shared between government and society." -- T. Rama Prasad
----------------------------------------------------------------------------------------------
"Uncertainty is the only certainty of Corona
which goes laughing all the way to the blood bank."
which goes laughing all the way to the blood bank."
-- T. Rama Prasad
--------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------
"Uncertainty is the synonym of this ominous and looming pandemic.
Lockdowns are kaput - Epidemiologists fainted - Economic analysts confounded
Lockdowns are kaput - Epidemiologists fainted - Economic analysts confounded
The world is now trapped in lockdowns." -- T. Rama Prasad
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
Everybody wants to go back to the "BUSINESS AS USUAL & MAKE MONEY" mode. But, Miss Corona says: "Well, at the risk of your LIFE."
-- T. Rama Prasad
---------------------------------------------------------------------------------------------------
"If you destroy NATURE, Miss Corona would wipe you out with NUCLEIC ACIDS, not NUCLEAR WEAPONS." -- T. Rama Prasad.
---------------------------------------------------------------------------------------------------
"Panicky over-reaction to corona deaths has destroyed global economy;
Strict implementation of 'hygiene advisory' would have been sufficient."
Strict implementation of 'hygiene advisory' would have been sufficient."
-- T. Rama Prasad
----------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------
"Going forward, the COVID-19 could become a 'viral/bacterial syndemic' posing to kill many more synergistically by joining hands with other microbes, what with the antibiotic resistance across the world and the weakened immunity."
------------------------------------------------------------------------------------------------------
"Not getting into the 'whirlpool' of an ICU with a 'cytokine storm' is a profit of tens of lakhs of rupees." --
-----------------------------------------------------------------------------------------------------------------------
An 'umbrella' of an ICU in a 'cytokine storm'. -- T. Rama Prasad
------------------------------------------------------------------
"The virus is the GULLIVER; The human is the LILLIPUT." -- T. Rama Prasad
----------------------------------------------------------------------------------------------------
When two or more epidemics interact synergistically to produce an increased burden of disease, we call it a 'syndemic'. The Asian Influenza Pandemic of 1957 killed not only by primary viral infection, but also by secondary bacterial infections. It was a viral/bacterial syndemic. Now, the COVID-19 can join hands with other microbes and cause further havoc.
https://www.thehindu.com/opinion/op-ed/preparing-for-a-syndemic/article31617304.ece
------------------------------------------------------------------------------------------------------------------------
SARS (Nov 2002 to July 2003) was a coronavirus that originated in Beijing, China spread to 29 countries and infected 8,096 people and killed 774 people (CFR 9.6%)
MERS (2012) infected 2,494 people and 858 people died (CFR 34.4 %)
------------------------------------------------------------------------------------------------------------------------
MOSQUITO
Another cause of concern is the possible alarming emergence of other diseases like dengue and malaria with the upcoming monsoon season associated with mosquitos in tropical South Asia. Chennai city reported over 400 cases of dengue in 2019. Thousands of "Domestic Breeding Checkers" (DBCs), as they are called to control mosquito breeding places around residential areas, are now diverted to 'Corona Duty'. This may lead to increase in mosquito related diseases.
MOSQUITO
Another cause of concern is the possible alarming emergence of other diseases like dengue and malaria with the upcoming monsoon season associated with mosquitos in tropical South Asia. Chennai city reported over 400 cases of dengue in 2019. Thousands of "Domestic Breeding Checkers" (DBCs), as they are called to control mosquito breeding places around residential areas, are now diverted to 'Corona Duty'. This may lead to increase in mosquito related diseases.
THE CONFUSION OF UNCERTAINTY
They are all there to confuse -- contradictory findings -- Correct information, fake news and believed knowledge -- nothing certain. Graphs. Mathematical models. Epidemiological projections. Scientific predictions, both alarmist and comforting, proved wrong. Pre-prints. Peer-reviewed publications. Retracted articles in medical journals. Statistical firm data. Evolving evidence. Inconclusive meta analysis. Masks must ... not necessary. 3 feet distance ... or 6 feet ... or 18. BCG protective ... not protective. Virus lives for only a few minutes ... no, for many days. Infects through cough ... even when one just speaks. Through door knobs. Through newspapers. HCQ wonder drug ... it may also kill. Plasma therapy life-saving ... may be dangerous too. Gangajal. Gomuthra. Kashayam. Chloroquine, Kudineer. Hot water drinking. Hot climate. Sauna bath. Sun bath. Smoking protects. Covid harmless to most. Not very lethal. Kills within hours. Timely treatment saves. No specific treatment. A normal person may infect. Lockdowns good. Very bad too. Disinfectants good ... harmful. Lockdowns ... ultimately gaining health and wealth. Truth ... untruth. Certain ... uncertain. Learn ... unlearn. Children are immune, and about 100,000 kids tested positive in just two weeks in July 2020 in the US alone. Elders more affected, Children more infective, False negatives 30%, False positives alarming. SARS-CoV-2 or D614G mutant ? Lockdown for 3 weeks. One more month. And more months. And finally, LEARN TO LIVE WITH IT !
The 'social distance' was 3 feet ... then it was made 6 feet. Now, with this information published in the journal 'Physics of Fluids', it seems it is to be increased to 18 feet ! With movement of air around at the speed of 4 kmph, droplets can go up to 18 feet in 5 seconds, it said. Right now (20.05.2020) the wind speed of the Amphan cyclone, hitting West Bengal and Bangladesh, is such that the droplets can travel up to 720 feet in 5 seconds !!! Safe distance may now mean 10 passengers in a big bus and 30 passengers in a big plane !!! Oh, invisible Corona, what a power you have ! You have distanced even the gods in the temples from us ! Uncertainty about you is the only certainty !
MODE OF TRANSMISSION
Mode of Transmission of CORONA: The WHO is being pressurised by 237 specialists around the world to revise its advisory by taking AIRBORNE infection into consideration. The WHO seems to be hesitant as it may lead to advising mandatory indoor air systems to filter out particles, and provision of ultra violet disinfection in hospitals and public establishments, and medical masks for the public -- all of which may not be possible in lower income countries.
CORONA PANDEMIC - CORONA INFODEMIC - CORONA ANXIODEMIC / PSYCHODEMIC
A lot of confusion is infused by the other pandemics - 'Infodemic', etc.. Unsolicited information 24/7 through countless channels had driven us into another pandemic - 'Anxiodemic'. Anxiety, tension and fear. We feel engulfed. The fear is such that, even when the lockdown is lifted, we shall still remain in a foetal crouch !!!
"Uncertainty is the only certainty of Corona
which goes laughing all the way to the blood bank."
which goes laughing all the way to the blood bank."
-- T. Rama Prasad
Schrodinger’s cat … alive or dead ? -- BOTH
Coronavirus … living or non-living ? -- BOTH
Lockdowns … success or failure ? -- BOTH
Un-lockdowns ... relief or danger ? -- BOTH
Coronavirus … did good or bad ? -- BOTH
ICU patient … alive or dead ? -- BOTH
Everything looks like the Schrodinger's cat !
Look for the cat in the link below:
https://www.themonitor.com/2020/03/24/commentary-outsmarting-virus/
They are all there to confuse -- contradictory findings -- Correct information, fake news and believed knowledge -- nothing certain. Graphs. Mathematical models. Epidemiological projections. Scientific predictions, both alarmist and comforting, proved wrong. Pre-prints. Peer-reviewed publications. Retracted articles in medical journals. Statistical firm data. Evolving evidence. Inconclusive meta analysis. Masks must ... not necessary. 3 feet distance ... or 6 feet ... or 18. BCG protective ... not protective. Virus lives for only a few minutes ... no, for many days. Infects through cough ... even when one just speaks. Through door knobs. Through newspapers. HCQ wonder drug ... it may also kill. Plasma therapy life-saving ... may be dangerous too. Gangajal. Gomuthra. Kashayam. Chloroquine, Kudineer. Hot water drinking. Hot climate. Sauna bath. Sun bath. Smoking protects. Covid harmless to most. Not very lethal. Kills within hours. Timely treatment saves. No specific treatment. A normal person may infect. Lockdowns good. Very bad too. Disinfectants good ... harmful. Lockdowns ... ultimately gaining health and wealth. Truth ... untruth. Certain ... uncertain. Learn ... unlearn. Children are immune, and about 100,000 kids tested positive in just two weeks in July 2020 in the US alone. Elders more affected, Children more infective, False negatives 30%, False positives alarming. SARS-CoV-2 or D614G mutant ? Lockdown for 3 weeks. One more month. And more months. And finally, LEARN TO LIVE WITH IT !
The 'social distance' was 3 feet ... then it was made 6 feet. Now, with this information published in the journal 'Physics of Fluids', it seems it is to be increased to 18 feet ! With movement of air around at the speed of 4 kmph, droplets can go up to 18 feet in 5 seconds, it said. Right now (20.05.2020) the wind speed of the Amphan cyclone, hitting West Bengal and Bangladesh, is such that the droplets can travel up to 720 feet in 5 seconds !!! Safe distance may now mean 10 passengers in a big bus and 30 passengers in a big plane !!! Oh, invisible Corona, what a power you have ! You have distanced even the gods in the temples from us ! Uncertainty about you is the only certainty !
MODE OF TRANSMISSION
SARS-CoV-2 is transmitted from person to person via small respiratory droplets. For more information on these droplets and masks, read further below on this page under the subheading "MASKS"
The droplets are generated when a person with the virus exhales, talks, sings, shouts, coughs, or sneezes. One can contract the virus if one breathes in these droplets. This is the basis for "face masks and physical distancing".
Large (5 to 50 microns, with more viral load) respiratory droplets containing the virus quickly settle down within about 5 seconds on surfaces and objects nearby within 2 metres due to heaviness and gravity. It’s possible that one could acquire SARS-CoV-2 if one touches mouth, nose, or eyes after touching a surface or object that has the virus on it. However, this is not thought to be the main way that the virus spreads. This is the basis for "hand-wash and sanitisation" recommendation.
The small droplets (less than 5 microns with lesser viral load, called Airborne or aerosol or micro droplets) may hang on for a long time, may be minutes, hours or more, in enclosed spaces and be aloft and carried on by air currents which when inhaled may cause infection. These small aerosol droplets may spread much beyond 6 feet, may be tens of metres, and infect people ('airborne' infection) who are even a bit far away. In a well ventilated room, these droplets are carried out of the room quickly and get diluted by the the plenty of air outside losing their infective potential, as the viral load (quantity and density of viral particles) is also a deciding factor in infection. This is the basis for recommending 'open-air' restaurants, 'out-door' meetings and vehicles with windows open, in contrast to 'closed air-conditioned' facilities and vehicles.
For more details, click on the links below:
"If the mode of transmission is understood and the imperative preventive measures are strictly practised by the entire populations around the world, the disastrous economic destruction due to lockdowns could have been avoided. And the COVID-19 patients could have been treated according to the need without the terrifying mass quarantines of stupendous negative impacts." -- T. Rama Prasad
CORONA PANDEMIC - CORONA INFODEMIC - CORONA ANXIODEMIC / PSYCHODEMIC
A lot of confusion is infused by the other pandemics - 'Infodemic', etc.. Unsolicited information 24/7 through countless channels had driven us into another pandemic - 'Anxiodemic'. Anxiety, tension and fear. We feel engulfed. The fear is such that, even when the lockdown is lifted, we shall still remain in a foetal crouch !!!
Though COVID-19 is exceptionally infectious, it is not very lethal. In fact, 90% of the cases in India had no or only minor symptoms, and deaths are less than 4%. So get rid of the FEAR first.
The alarmist predictions on Covid proved wrong. On a larger canvas, the damage done by the virus does not seem to be huge, especially in India, up to July 1, 2020. Less than 18,000 people died in India as on 01.07.2020 due to COVID-19. It is a small number compared to 4,35,000 deaths due to TB annually or 1,50,000 deaths due to road accidents per year, in India. How about deaths due to other diseases ? Too many. Ten million Indians die every year of various causes. Just look at the figures for the lockdown period of 6 weeks (March 25 to May 5) -- India's pro-rated death toll from all causes would be 10 lakhs, including due to -- influenza and pneumonia of 75,000, TB of 54,000, diarrhoea of 50,000, road accidents of 32,000 and suicides of 24,000.
All this means that the 'Infodemic'-focussed media have set the eyes of the whole country on only one coronavirus death out of 638 total deaths ! We had been kept in the dark about the other 637 deaths ! Compared to the Western countries, Covid-19 death rate in India is low due to multiple factors (see the list of 13 below), including local conditions which have an impact on epidemic trajectories. Fortunately, the virus by itself didn't affect India much so far due various factors (mentioned below under the subheading "Unanswered Questions"). But the collateral damage is huge. Hence the small number of corona deaths need not cause fear. Get rid of the FEAR first. Think more about the 'SIDE EFFECTS".
Points of discussions may be hypothetical and revolve around conjectures, especially when India is a data-poor country when it comes to human health.
We had many pandemics before. But this one is a little different. It killed fast (though not too many) and spread fast in highly empowered countries which brought it into focus and undue magnification by media. Otherwise, it is just another flu, albeit with more kill-power. But the fear had driven many societies into miscalculated and random 'lockdowns' associated with economic disasters. 'Social Media Distancing' may be a preventive measure against overreaction ! Indeed, many of the ailments, physical and mental, even in the pre-corona days, were due to the Internet.
A UK study, published on July 22, 2020, from the found that viewing TV for more than two hours a day resulted in an increase of 6 per cent of all-deaths and 8 per cent of cardiovascular deaths. There has been an enormous increase in TV viewing during the 'corona lockdowns'.
A UK study, published on July 22, 2020, from the found that viewing TV for more than two hours a day resulted in an increase of 6 per cent of all-deaths and 8 per cent of cardiovascular deaths. There has been an enormous increase in TV viewing during the 'corona lockdowns'.
CORONA era cars: Ford introduces a new model in 2032 -- Ford Corona V-19. Two seater - one front & one back, just like all other cars. Fitted with Ultraviolet Disinfection lamps, and virus alarm system. Automatic oxygen pumping when O2 saturation falls. Sleek antique design like the 1932 model. No guarantee or warranty just as for human life, with COVID-29 around. -- Dr. T. Rama Prasad, Perundurai. THE LOCKDOWN CONUNDRUM
"Uncertainty is the synonym of this ominous and looming pandemic.
Lockdowns are kaput - Epidemiologists fainted - Economic analysts confounded
Lockdowns are kaput - Epidemiologists fainted - Economic analysts confounded
The world is now trapped in "Chakravyuh" of Abhimanyu -- the intriguing maze. How to come out ?" -- T. Rama Prasad
"The most absurd expectation from a "lockdown" is that it is a totally effective eradicator of the virus. The truth is that it is the costliest medicine with a little effectiveness and a lot of serious side effects." -- T. Rama Prasad
"Lockdown is a reserve drug to be used sparingly in selected cases which are resistant to safer drugs, in view of its long term serious side effects. It's not a panacea for all Covid ills." -- T. Rama Prasad
In this context, there is one crucial question to be answered. Will the SARS-CoV-2 linger continuously or mutate itself into oblivion soon ? If we had known the answer, we could have avoided the disasters we made for ourselves.
Is the 'lockdown' right or wrong ? Is the Schrodinger's cat alive or dead ? Is the virus a living or non-living particle ? The answer is 'BOTH'.
'Lockdown' is a double-edged sword. It is a fiercely debatable subject. See how they are fighting in the US -- Donald Trump and the fear-mongering welfarism -- the Republican Red States and the Democratic Blue States, for and against lockdowns ... Tesla Inc chief dared arrest saying he would open his factories against the law, and threatened to move his gigantic factories from California to Texas. Paradoxically, the US, the most empowered country on the planet is the most adversely affected one by the Covid. And, its president, the most powerful man in the world, seems to believe that the pandemic controlling honchos and the highly talented academic brains are not necessarily the best or smart people around. It may sound a trifle ironic that the US president is against lockdowns and is at loggerheads with Anthony Fauci, the top medical advisor to the US. The virus issue has become an international political issue too, with tensions ratcheted up between Washington and Beijing as they trade barbs over the origin of the virus.
Considering the vicious nature of the virus, we shouldn't let our guards down and simply surrender to destiny. There is no uniform default strategy for all and we have to make course corrections nimbly to maintain a balance between economic and public health costs and benefits. It is like being on a Schrodinger's seesaw. And also we should remember that the virus killed the economy despite not imposing a lockdown in Sweden.
One must first understand the mode of spread of this disease and observe all the precautions according to the advisory given by the public health authorities. This is the surest, safest and most economic way of containing this scourge. Even a rigid lockdown does not ensure proper wearing of a right mask, keeping the prescribed physical distance, washing hands as advised, observing personal hygiene, informing about contacts and seeking treatment early. Does the lockdown ensure all this ?
If not, it can't yield the expected results. Don't bother about the results on the disease, but what about the disastrous economic side effects ? Fatal, more fatal than COVID-19 !!! Lockdown is a blunt instrument which can't cut the root cause, whatever be the epidemiologists say showing mathematical models. It may be used in a limited tailor-made way and as a situation specific strategy. Not as a wholesale total lockdown all over a country for indefinite periods, as it's not a whole remedy without serious side effects. This is applicable to all the countries.
Both the 'Corona Virus' and the 'Lockdown Virus' originated in China and spread across the globe. The non-sustainable 'lockdown' has become a default strategy and an epidemiological fashion, based on mathematical models and a limited theoretical frame. An indefinite transnational blanket ban on all activities just to tame one disease is an example of profound insanity.
SCENARIO in INDIA
India had been under LOCKDOWN (march 25 , 2020 onwards) which was considered as the most effective preventive step to stem the rot. The Central Government has been in a mission mode and the State Governments have to be as proactive. Ultimately, it is in the hands of the people. It all depends on how meticulously they follow the advisory and the rules. The bitter pill may not be liked, but the result would be sweet, if all goes well according to the plan. The "IF"is the problem.
However, there are experts in the field who think sceptically about the benefits of lockdown. It may all depend on the specific situation in a locality or the country at a particular point of time. An editorial in a world famous medical journal, The Lancet, didn't consider the lockdown as favourable for India (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30938-7/fulltext ). Our own advisors seem to have followed double standards as can be inferred from the photocopy attached below:
It is LIFE versus MONEY. Without life there's no money, and without money there's no life. It's the affordability of a country that should decide the type of the 'LOCKDOWN'. Different 'pundits' expressed different views. America is an example of the conflict, Trump backing the protestors against lockdown in some States. For India, perhaps, a 'soft and selective lockdown' without a big blow to economy might have been desirable, along with very rigid restrictions in hotspots like Dharavi in Mumbai.
The number of deaths due to COVID-19 would be nothing (even without lockdown) when compared to the present and future deaths indirectly due to lockdown (due to the inevitable negligence of other health problems, disruption of regular vaccination schedules, lack of money for healthy living and medical care, etc.). The harsh reality is that a huge portion of the population is suffering from various infectious and non-infectious diseases. It is an international disgrace that 1,000 persons have been dying of TB every day in India in spite of the half-a-century-old national TB control programme, let alone the deaths due to other causes. Even across the world, every year, around 5 lakhs of people die due to 'flu' (seasonal influenza) viruses, around a thousand a day.
Lockdown -- what's the big deal -- using a sledgehammer to crack a nut !!! The troika of "1. masks, 2. distancing, 3. hand hygiene", used in a measured and logical way, would have been sufficient for India, along with improved 'healthcare infrastructure' which is notoriously creaky and rickety what with just 1.3% of GDP on health care (compared to 17% - $3 trillion - of the US). We can't fix decades of neglect while in the throes of a pandemic.
MY COMMENT --- to tread the comment, please go to the subheading "THE CORONA CONUNDRUM" above.
There are various ways of assessment. One is to apply the 'human capital' concept of economics. People die in pandemics ... in massive numbers ... magnitude varies from country to country due to varied circumstances. As a byproduct of 'infected cases', immunity develops in the surviving population. 'Survival of the fittest' of Darwin's theory -- immunity is the only long term asset. Perhaps, the low death rate in India is due to the 'herd immunity' we have. Preventive precautions are to be taken, including lockdowns which are to be implemented judiciously depending upon the specific local factors and the possible economic impact. Sometimes, mathematical and epidemiological models may go for a toss and decisions made on their basis may ignore the seriousness of other compelling adversities on health and economy. Other diseases don't get proper attention. Disproportionally large damage may occur to the health of the citizen due to the surge of non-Covid diseases for various reasons like inaccessibility to treatment and a break in general vaccination schedules. In such circumstances, a midcourse correction from highly flawed lockdowns to less flawed followups is to be made.
According to a study conducted in South Africa a lockdown would kill 29 times more people than it saves. The extent of economic damage would be anybody's guess. According to a mathematical model by two former senior scientists of CSIR / NIIST (Ajit Haridas and Roschen Sasikumar), lockdowns would be ineffective when started too early when only less than 1% of the population is infected, and it takes more than 70 days to cross the 1%; day 70 to 100 -- 22.5%; day 100 to 140 -- 1% again without intervention. First, the 'herd immunity' must be let to develop, before taking the drastic step of lockdown. But, herd immunity may take a very long time to develop. And nobody knows how long the immunity developed after recovery would last.
https://www.medrxiv.org/content/10.1101/2020.05.06.20093104v1However, one economic assessment says: If there is no lockdown the economic loss due to 5 million deaths would be about Rs. 20 lakh crore. If there is a lockdown the economic loss due to disruption of production would be only Rs. 7 lakh crore -- https://www.newindianexpress.com/opinions/2020/may/07/lockdown-an-economically-sound-decision-2140161.html . Now, look at the figures below:
India's industrial output, as measured by IIP, contracted by 16.7% in March, 2020. A mega 10% of GDP, Rs. 20 lakh crore stimulus package was announced by the Prime Minister of India on May 12, 2020, after about 50 days of lockdown, to help nurse the economy back to health.
During the corona period we have cultivated a 'tube vision' which lets us see only about corona, blind to other diseases, hunger, deprivation, present and future livelihood, future GDP, etc. And, the 64 million city-slum-dwellers and the scores of migrant labour were outside the field of vision when the surgical move of the lockdown was a 'breaking news'. Or was it a 'braking news' ?It is highly complex -- it's not like switching-on and switching-off a light. With just an order everything can be locked down, but can't be opened the same way. Lots of risks -- risk of more number of cases, risk of not getting back production, economy, health and life to the 'old normal' in the near future. Even inside the health care system, the COVID-19 has crowded out 'non-covid' care, both public and private, to almost nil, as the days rolled on and the lockdown moved on from phase to phase -- 1 to 4. This may lead to stupendous 'non-covid' health problems in future. Is the country's multi-layered health system being sacrificed at the altar of one virus ?
India -- 9 weeks after lockdown ... 01.06.2020
Benefit or Loss ? None can give a satisfactory answer as the issue is riddled with a multiplicity of factors in India, including statistical inaccuracies. It is an experiment.
Prime Minister Narendra Modi wrote / said on 29.05.2020 that despite tremendous suffering due to the lockdown, India has averted a huge corona disaster. On the same day, Dr. Balram Bhargava, Director-General of ICMR, said that though there has been a rise in positivity rate, the fatality rate could be kept low, in spite of the healthcare-spending being only around 1% of GDP. He seemed to have indicated helplessness when he expressed the hope that COVID-19 would also quit like H1N1 (swine flu) which suddenly came as a big wave, stayed for a long time and suddenly disappeared, some years ago.
India started the first phase of lockdown on March 24 and is going to enter the first phase of 'Unlock' on June 1, 2020.
In the first phase of 3 weeks, between March 24 and April 15, the number of cases had gone up by 20 times, and it is still growing even at the end of 2 months. Just in 10 days between May 18, 2020 and May 28, 2020 the number of positive cases had grown from 1,00,328 to 1,65,799 -- a whopping 65,000 increase. And in just 7 days between May 26 and June 2 the number went up from 1.5 to 2 lakh -- an alarming increase of 50,000 in one week. But the death rate is low which is the most important factor (0.3 deaths per one lakh of population -- lowest in the world). And sadly, the economy plunged down exponentially beyond any hope of full recovery in near future. Added to this is the pathetic collapse of the migrant workers livelihood and their miserable run to their native States which couldn't be foreseen. The impact of migrant work force on health and more so on industrial economy also could not be fathomed. Apart from the agony they suffered to travel back to their native places, they were stigmatised by their own people as virus carriers -- and in fact they might have spread the infection in remote rural areas where healthcare vigilance is substandard. .If the lockdown was only for three weeks, the workers would not have gone back and the employers would have fully supported them for those three weeks.
Proponents of the lockdown say that the situation would have been lots worse if the lockdown was not clamped and that a humongous catastrophe could be averted. The critics say that it failed to contain the spread. If it had failed, why it didn't work according to the expectations ?
The following may be the causes:
(a) The dense population and the deeply entrenched social customs and cultural conventions. 'Social distancing' is not practicable and can't be enforced in the vast heterogenous and congested India.
(b) For various reasons, people didn't and couldn't follow the 'health advisory'.
(c) Outbreaks occured at different places at different times, asynchronously', jeopardising calculations based on mathematical models.
(d) Owing to loss of income over extended periods, people went into negative thinking and failed to be compliant.
(e) This virus is different in its mode of spread and sustainability.
(f) Last, but not the least, it could be due to a flawed strategy based on just academic advice and mathematical models. Governmental hubris sans war-room thinking, keeping the private medical sector away from the battle field, the incoherent and rapidly shifting strategies and policies, etc may also be the reasons. Read: https://www.thehindubusinessline.com/opinion/indias-corona-strategy-is-very-amoebic/article31165263.ece
What should have been done and what should be done ?
Total lockdown for a long time may not be right for a country like India -- both for health and economic reasons, and both for short-term or long-term benefits. The following could have been done after the first phase of the lockdown:
(a) Strict and universal use of masks and hygiene measures at least until the end of 2020 at all places.
(b) Strict tailor-made location-specific restrictions depending on the situation in selected zones.
(c) Strict medical supervision of all the vulnerable -- elderly persons and all those having chronic problems of lung, heart, kidney, metabolic disorders, etc., irrespective of the age, at least until the end of 2020. If this segment is protected, the rest of the population is not at much risk.
(d) Prompt and proper treatment of all suffering from cough and fever.
(e) The rest of the majority of the working population could have been permitted at the end of the first phase of the lockdown to attend to their duties as usual, but taking all the precautions -- mainly using masks and hand-sanitisers. 'Social distancing' is neither practicable nor very necessary.
(f) All this should have been done at the end of the first phase (March 24 to April 15 during which period the number of cases had increased by 20 fold), as further extension of lockdowns would only worsen the overall situation, especially the livelihood and national economy, and as it may take another six months or even more to ideally 'flatten the curve' or to reach the 'bottom line'. Just imagine the extension of lockdowns until the end of the year or even after, as it would take a long time to achieve ideal epidemiological goals for lifting the lockdown.
Total lockdown for a long time may not be right for a country like India -- both for health and economic reasons, and both for short-term or long-term benefits. The following could have been done after the first phase of the lockdown:
(a) Strict and universal use of masks and hygiene measures at least until the end of 2020 at all places.
(b) Strict tailor-made location-specific restrictions depending on the situation in selected zones.
(c) Strict medical supervision of all the vulnerable -- elderly persons and all those having chronic problems of lung, heart, kidney, metabolic disorders, etc., irrespective of the age, at least until the end of 2020. If this segment is protected, the rest of the population is not at much risk.
(d) Prompt and proper treatment of all suffering from cough and fever.
(e) The rest of the majority of the working population could have been permitted at the end of the first phase of the lockdown to attend to their duties as usual, but taking all the precautions -- mainly using masks and hand-sanitisers. 'Social distancing' is neither practicable nor very necessary.
(f) All this should have been done at the end of the first phase (March 24 to April 15 during which period the number of cases had increased by 20 fold), as further extension of lockdowns would only worsen the overall situation, especially the livelihood and national economy, and as it may take another six months or even more to ideally 'flatten the curve' or to reach the 'bottom line'. Just imagine the extension of lockdowns until the end of the year or even after, as it would take a long time to achieve ideal epidemiological goals for lifting the lockdown.
The remedy of indefinite extensions of lockdowns would be worse than the malady. There is no silver bullet. This problem would persist and may even increase over a long period of time -- lockdown or no lockdown. We can certainly slow down the spread by taking some basic precautions like wearing masks and observing hygiene advisory, and more importantly taking care of the symptomatics and the vulnerable population. We don't know when a really effective vaccine would be available. Until then we have to learn to live with it, and we can't live without a livelihood. Very fortunately, for reasons not very clear, the death rate in India is quite low (0.3 deaths per lakh of population compared to 4.5 across the world and 29 of the US). And even the infection as a proportion to the huge population is not much (128 cases per million). And there is no need to resort to drastic and disastrous steps when people are not dying in abnormal numbers. Natural infection can go on, and it will go on, increasing the 'herd immunity'. The more the number of people we test, the more would be the number of positive results -- but it doesn't mean more number of patients. Majority of the people (80%) may not have any symptoms or only mild symptoms -- they only get more immunity through mild subclinical infection. It's an advantage. The main focus must be to keep the symptomatics and the vulnerable population safe and to keep the death rate low -- and it seems that the death rate is naturally low in India.
Finally, this is not to cast aspersions on anybody. But let us be honest. False statistical figures make us lose all the credibility. People around the world are wondering why the death rate due to COVID-19 in India is so low - lowest in the world at just 0.3 per lakh of population. Just have a look into the matter in the photocopies below and know what even our own experts feel about it. People of late have been obsessively tracking COVID-19 statistics, hour to hour, day to day. What would they think when they realise that these are just some numbers !
The police, officials and army, if necessary, could have been posted inside (now, they are outside) the work places and educational institutions to enforce preventive measures in addition to 'educate' them on precautions to be taken in daily life, letting the normal activities go on without affecting economy. it may all be hypothetical and conjectural due to insufficient information about this disease. Anyway, we are half way through now (01.06.2020). Let's see the results.
Finally, this is not to cast aspersions on anybody. But let us be honest. False statistical figures make us lose all the credibility. People around the world are wondering why the death rate due to COVID-19 in India is so low - lowest in the world at just 0.3 per lakh of population. Just have a look into the matter in the photocopies below and know what even our own experts feel about it. People of late have been obsessively tracking COVID-19 statistics, hour to hour, day to day. What would they think when they realise that these are just some numbers !
POST-MORTEM of the LOCKDOWN
The following observations highlighted by the hard-hitting joint statement issued by experts in the Indian Public Health Association (IPHA), the Indian Association of Preventive and Social Medicine (IAPSM) and the Indian Association of Epidemiologistsmay serve as a 'post-mortem report':
" ... The lockdown is draconian and based on flawed models presumably drafted by an influential institution which presented a worst-case simulation, which is shown to be way off the mark by subsequent events ... Had the government of India consulted field-level epidemiologists who have better grasp of disease transmission dynamics compared to modellers or theoreticians, the purpose would have perhaps been better served ... Enforcing the lockdown indefinitely would be too disruptive and the deaths due to the lockdown for various reasons may overtake lives saved due to the lockdown-mediated slowing of the COVID-19 progression ... From the limited information available in the public domain, it seems that the government was primarily advised by clinicians and academic epidemiologists with limited field training and skills ... India is paying a heavy price both in terms of humanitarian crisis and disease spread, because policy makers relied overwhelmingly on general administrative bureaucrats instead of engaging with expert technocrats in the areas of epidemiology, public health, preventive medicine and social science ... The incoherent and often rapidly shifting strategies and policies, especially at the national level, are more a reflection of afterthought and catching-up phenomenon by the policy makers rather than a well-thought and cogent strategy with an epidemiological basis ... Open and transparent data sharing with scientists, public health professionals and the public is conspicuous by its absence till date ... Had the migrant persons been allowed to go home at the beginning of the epidemic when the disease spread was very low, the current situation could have been avoided.
In a matter like this, opinions of experts do differ, but the hard-hitting collective observations made by the three highly recognised academic associations of authentic experts can't be brushed away as just another opinion. It is compelling on us to ruminate fundamentally on the wisdom of taking a decision to lockdown and on the way of conducting the lockdown.
Sunetyra Gupta, Professor of Theoretical Epidemiology at Oxford, England explains the downside of lockdowns. She said "The thought of lockdown imposed in India and other countries with similar problems sends chills through me ... I felt it was going to cause immense harm and untold damage. So, I don't think that it was a good solution ... This is just one disease. Let's face it, we don't have the infrastructure in place to prevent the deaths occurring from TB, diarrheal disease and other respiratory infections. We don't have the health infrastructure and that is an international disgrace ..." For more, go to:
https://timesofindia.indiatimes.com/blogs/the-interviews-blog/we-cannot-look-at-this-epidemic-as-a-single-axis-of-how-many-people-are-going-to-become-infected/
It is pathetic that the society had to respond to the lockdown, extended lockdowns and reimposition of lockdowns as though they were "Law and Order" problems. Rigid implementation of the rules without sensitivity and pushing people into nightmarish quarantines, hellish and fatal run of the migrant labour along railway tracts, alleged custodial torture for minor violations of the lockdown, etc had distanced people from voluntary participation. People had become terrorised more because of the HEAVY-HANDED POLICING-LED actions and quarantines rather than the VIRUS. Virus fear went into the background in the minds of the people. It's reported that about 50 per cent of the people tested for the virus give false addresses and phone numbers to evade follow up and quarantine. They are said to be tracked , traced and treated like criminals -- and imagine the stigma factor. People are afraid of going out for a morning walk, even with masks on deserted roads, for fear of being fined 100 rupees (see the receipt attached).
The lockdowns translated like this: authoritative rules -- police -- arbitrary actions -- shifting policies -- incoherent plan -- punishments -- quarantines -- inconveniences -- stigma -- loss of livelihood -- hunger -- pain -- uncertainty of future and everything -- resentment -- loss of trust -- evasion. Evasion even to seek medical aid for fear of quarantine and stigma. This led to cases going underground, breeding more viruses. Under these circumstances, many doctors and private hospitals were reluctant, even afraid, to attend to patients, putting forth some excuse or other. For instance, see the misfortune of the Bangalore patient and the Coimbatore patient in the attached clippings alongside. Partnership between the 'public medical sector' and the 'private medical sector' was woefully lacking, for various reasons. This is the reason for the private medical sector to evade. There is a 'built-in negative factor' in our litigation system. Why many doctors and hospitals shun to take care of road accident victims ? For that matter why people passing by the accident sites on Indian roads generally evade to stop and help the victims ? You can see the ground realities in the attached clipping with the heading "Don't turn away patients ..." -- an edifice of reluctance and enforcement ! It reflects 3 things -- 1. Inhumanity 2. Authoritarianism 3. Impracticability of complying with protocols and the capping of the charges.
https://timesofindia.indiatimes.com/blogs/the-interviews-blog/we-cannot-look-at-this-epidemic-as-a-single-axis-of-how-many-people-are-going-to-become-infected/
It is pathetic that the society had to respond to the lockdown, extended lockdowns and reimposition of lockdowns as though they were "Law and Order" problems. Rigid implementation of the rules without sensitivity and pushing people into nightmarish quarantines, hellish and fatal run of the migrant labour along railway tracts, alleged custodial torture for minor violations of the lockdown, etc had distanced people from voluntary participation. People had become terrorised more because of the HEAVY-HANDED POLICING-LED actions and quarantines rather than the VIRUS. Virus fear went into the background in the minds of the people. It's reported that about 50 per cent of the people tested for the virus give false addresses and phone numbers to evade follow up and quarantine. They are said to be tracked , traced and treated like criminals -- and imagine the stigma factor. People are afraid of going out for a morning walk, even with masks on deserted roads, for fear of being fined 100 rupees (see the receipt attached).
Section 65 and 66 of the Disaster Management Act 2005 and the Private Clinical Establishment Acts don't ensure empathy. Nobleness should come from the bottom of the heart, not from the words 'Noble Profession'.
All this led to: (1) Unavailability of service. (2) Seemingly exorbitant charges.
July 1, 2020 -- DOCTORS DAY. We doctors thank you all for the greetings. We want to keep the "PATIENT FIRST" in our minds. This is AC era (After Corona). Patients are afraid of going to doctors. Doctors are afraid of attending to patients. 'Fear Pandemic' is worse than the 'Virus Pandemic'.
In India, we have a wide range of private and public treatment options. So, we have plenty of complaints with regard to Corona treatment as can be seen in the clippings attached below. In the private sector, the range is from a cheap unqualified charlatan charging less than 50 rupees to a state-of-the-art corporate hospital charging even more than 50 lakhs of rupees to treat a case of COVID-19. Option is there, no compulsion. The high charges may be justified on the grounds of high investment and sophisticated treatment -- a shot of medicine may cost 50 thousand rupees. These high-end hospitals are meant for the wealthy. The wealthy don't mind high charges so long as they are right. The grievance of even the rich is lack of transparency in accounting, exploitation and profiteering, as it is well known that some of the hospitals have mastered the art of 'creative accounting', bordering on to shameful robbing in the 'Noble Profession'. On the other hand, the managements of the private hospitals lament that they are economically struggling even for their existence. This also is to be considered, in view of the huge capital invested and the expensive maintenance. The other option is government health facilities. With 1.3% of GDP for them and the harsh realities of prevalence of red tape, what else can they do ? The bottom 70% in the financial scale in India have to be content with the vagaries and mercy of the unpredictable public health care sector.
In this context, an article by Dr. Raj B Singh on the justification for the private hospitals for charging what is economically viable for them, and the need for the 'public health care sector' to do what the 'private medical care sector' is doing now as a solution to the problems is worth reading -- https://www.thehindu.com/opinion/op-ed/needed-a-transfusion-for-public-health-care/article31798593.ece .
 |
| Profiteering or Struggle for existence ? |
Adverse relationship with communities developed instead of 'public-private partnership' among people which only spells success in public health initiatives. Making people voluntarily participate is a very sensitive issue which calls for sympathy, empathy and understanding. People should be made to understand the situation clearly and make them receptive to the ideas. The activity so far, to some extent, looked like an exercise that is usually done to maintain 'law and order'. Police batons, arrests and punishments shouldn't be the first-line deterrents. Invoking Authorities say that force is to be used as the people don't understand the gravity of the situation and cooperate.
All this is written without prejudice and bias. This is based on the views of various experts in the field -- of course, experts disagree on issues, and the myriad of reports.
https://www.thehindubusinessline.com/opinion/indias-corona-strategy-is-very-amoebic/article31165263.ece
https://www.thehindu.com/opinion/op-ed/can-indias-workforce-have-a-safe-return-to-business/article31698049.ece
"Clear understanding of the facts about this disease and voluntarily applying the knowledge goes a long way to prevent morbidity and mortality, rather than applying coercive and punitive measures."
-----------------------------------------------------------------------------------
"TRAVEL DISTANCE"
"WORLD ENVIRONMENT DAY: We have come to this level of "Travel Distancing" because we (the real viruses) destroyed environment which resulted in new diseases, droughts, floods, cyclones, earthquakes, etc. Save 'NATURE' and save the PLANET". -- T. Rama Prasad.
THEN, WHAT TO DO ?
What should we do now ? For the larger good of the planet, JUST UNLEARN -- unlearn the bad materialistic lifestyle learnt over the past one century; unlearn the unkind attitude to nature and man developed over the past one century. This is just not to get out of the fire of the Covid-19, but to have a good life in the long future. JUST UNLEARN. And, follow the health advisory given by healthcare officials to tide over the present crisis -- personal hygiene, social responsibility, physical distancing, masks, etc. "Let's not debate. This virus has come here as a permanent guest. Let's not be obsessive to eradicate it. Even if we lockdown for 3 years, it would be there, mutating continuously. We have to act in a smart and nimble way where responsibility is shared between government and society."
SOCIAL VACCINE
We have to use the vaccine that is available now. It is the 'SOCIAL VACCINE', made by lockdowns, that is to be taken seriously by everybody around the world. 'Social Responsibility, 'Personal Hygiene', 'Lifestyle Modification' and 'Preserving Nature' are the main ingredients of this vaccine. Don't foolishly think that lockdown is the remedy and the end of corona crisis -- this is just the beginning. Lockdown is just a short-period demonstrative and training course of lessons in the 'classroom at home' to learn how this 'Social Vaccine' is to be taken in course of time. Last but not the least is 'Preserving Nature' which only has the long lasting benefit.
After the 'lockdown' is lifted, leave this 'classroom at home' and take this 'Social Vaccine' daily as a routine until a really effective biomedical vaccine is made. And, it is most unlikely that a 'Really Effective' vaccine can be made in the near future. This means that you have to take these preventive measures indefinitely for a long time even if you are free to go out for work or studies. Miss Corona would be our permanent guest.
"MASKS or LOCKDOWNS: If masks were worn universally since the start of the journey of Miss CORONA, there wouldn't have been a need for the lockdowns. Perhaps, due to their 'mask-wearing culture', Japanese and South Koreans had low 'covid mortality', even without lockdowns." -- Dr. T. Rama Prasad, 'Pay What You Can' Clinic, Perundurai.
Our research of 40 years didn't find a really effective vaccine against HIV/AIDS which has killed about 35 million people so far. Measles persists despite having a vaccine. I shall tell you the story of the efficacy, failure and commerce of influenza vaccines later. HIV could be controlled to some extent because of the awareness of the cause and consequences; behavioural change and sexual discipline (a kind of 'Social Vaccine'); not through conventional vaccines, medicines and legislation. Same seems to be the case with Covid-19. The 'Social Vaccine' (social responsibility, personal hygiene, lifestyle modification and preserving nature) delivered through the 'lockdown school' is the only hope to get out of this crisis; not punitive legislation, not hospitals, not further lockdowns.
If carrots didn't work in the class room, teachers used canes ... in the corona case, the caning would not be from teachers or police, it will be from COVID-20 !!! The Westerners need to learn this lesson seriously, lest they would sink the whole world to unfathomable depths.
DON'T GET SCARED ... use the troika of 'masks, physical distancing and hygiene', in a logical and measured way. Cooperation of the public and the participation of the 'private medical sector' are crucially needed. Mid-course corrections are necessary as there are many knowledge gaps in the 'corona compendium'.
Further reading:
https://www.thehindu.com/opinion/lead/a-shot-of-hope-with-a-game-changing-vaccine/article31383184.ece (article by Dr. T. Jacob John, Virologist & Dr. Prathap Tharyan, Epidemiologist -- both from Christian Medical College, Vellore -- published in The Hindu of April 20, 2020)
Dr. T. Jacob John is a former Professor of Virology at Christian Medical College, Vellore. Interestingly, I am having a letter written to me 34 years ago in 1986 by him in connection with an AIDS suspected case seen by me, a couple of months before the first batch of six AIDS positive cases were detected in India by Dr. Jacob John ! A photo copy of the letter is attached below for historical curiosity. At that point of time, there were no facilities in India to do Western Blot test for AIDS. So, the blood samples of these six individuals along with those of another 120 persons from Madras were flown to the USA for the confirmatory test, by the Vellore ICMR centre !
-- T. Rama Prasad
-- T. Rama Prasad
---------------------------------------------------------------------------------------------------
Everybody wants to go back to the "BUSINESS AS USUAL & MAKE MONEY" mode. But, Miss Corona says: "Well, at the risk of your LIFE."
-- T. Rama Prasad
---------------------------------------------------------------------------------------------------
"If you destroy NATURE, it would wipe you out with NUCLEIC ACIDS, not NUCLEAR WEAPONS." -- T. Rama Prasad.
---------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------
My close relative, Dr. Bhagyashri Navalkele is the Medical Director of Infection Prevention and Control at the University of Mississippi Medical Center (USA). She was born and brought up in India and had her basic medical education in Mumbai. She has been a 'game-changer' at the university's COVID-19 facility and the
https://www.clarionledger.com/story/news/2020/04/24/community-heroes-april-2020-ummc-doctors-play-key-role-coronavirus-fight/3004388001/
-- T. Rama Prasad
---------------------------------------------------------------------------------------------------
Bread is masculine and beer is feminine. Every noun in French has a gender. And now the Academic Franchise has decided to approve feminine form for COVID-19.
----------------------------------------------------------------------------------------------------
Dear Miss Corona,Good morning. You seem to be a smart and voluminous lady like our actress Sunny Leone or Vidya Balan. Researchers told us that you are the largest among known RNA viruses (0.125 microns) and that we may use even ordinary surgical masks instead of the expensive N95 masks to filter you out. We are lucky that you are not of the 'size zero' of the actress Kareena Kapoor !
You have become the most feared foe for us today. You have been so cruel to infect around 28,00,000 and kill about 200,000 humans and to crash down global economy shockingly, all within four months. You have sent the stock market into a tailspin of shock waves, made the airlines industry to nosedive causing a loss of hundreds of billions of dollars, and made our Indian dream of '$5 trillion economy' move into the realms of fantasy by impacting our trade by about hundreds of millions of dollars, all within a span of four months. All our developmental plans had gone for a toss. You had closed even our big temples, including Tirupati Tirumala, let alone huge malls, markets, theatres and tourist spots even before the 'LOCKDOWN' in our country. Loss on tourism sector would be of gargantuan proportions. All this you did within a short span of about four months ... we are terrified of what is yet in store for us, and we are scurrying around like headless chicken, not knowing how to contain you. What with all the WHO declaring you as a 'pandemic' scourge of stupendous stature.
You have a well planned agenda to kill. You killed the whistleblower Dr. Li Wenliang who posted early warnings of your presence on this planet on his social media group. Also you killed Dr. Liu Zhiming, Director of Wuhan Wuchang Hospital who was trying to save people from your attack. And you infected most of the medical staff in Wuhan and many in the West too, and killed more than 100 doctors in Italy. You have terrorised the affluent Western societies by infecting lakhs of people and killing about half-a-lakh, and driving the British Prime Minister, Boris Johnson into ICU. And, you killed 2,000 in one day on 07.04.2020 in America alone, and a total of around 17,000 in Italy alone (much more than the fatality of about 4,000 in China). Your performance is acclaimed to be the best when you infected about 8,00,000 and killed about 45,000 in the indomitable America, the US. As on April 22, 2020, you made a whirlwind tour across the globe and infected about 28,00,000 people and killed nearly 200,000 in 210 countries / territories !!! Your most speedy and stunning blow is on the US which is highly empowered with grand health infrastructure ... you seem to be more angry with America ... perhaps, you don't like the one-upmanship of 'Uncle Sam' and his arrogance.
But, Miss Corona, why are you doing all this ? ... A revenge ? What harm we humans did to you ? ... Oh, that's it ? We had tinkered with nature and caused an ecological imbalance in the forests where you were residing in animals ... yes, it's true ... we disturbed you all. Out of sheer greed, we encroached the territory of wildlife and deprived them of food and water ... so the animals, bats, birds, etc. are forced to come out of the wild into human habitations. And you viruses also came along with them and jumped from them into us to taste our blood with impish glee. Alas ! What to do now, Miss Corona, to send you back into the forests ? We can't go back to the good old culture and habits. We can't change the environment. We are incorrigibly addicted to 'modernity'. And you can't be bribed to strike a deal to send you back to the forests we deforested.
We humans, normal imperfect mortals, first think of buying you with money because we strongly believe that money would take care of everything -- jobs to judgments, taxes to temples, deprivation to depression, etc. ... the pernicious influence of our deep trenched systems make it seem that it is easier to get marks, degrees, jobs, licenses, approvals, certifications, and votes through money. Nothing vague or amorphous ... vulnerable to venality. Miss Corona, let me be honest ...if you are interested to know more about our nefarious "Kali-Yuga" activities, please click on the following two links, written by the internationally renowned scholar, Pritam Bhattacharyya (Editor-at-Large of Pentasect and Founder and Chief of Wordsmith at Wordsmith Communication, Chairman of Freelance Foundation, ) -- (1) https://wordsmithofbengal.wordpress.com/2012/01/16/health-un-heath-and-fear-of-un-health/
(2) https://wordsmithofbengal.wordpress.com/2012/04/23/google-effect-and-kali-yuga-prophecies/
(Pritam Bhattacharyya posted a comment on this 'scribbling' which may be seen at the end of this writing - wordsmith.)
If you are interested we can pay you a huge ransom through a global fund. We have nuclear arsenals to annihilate humankind en masse but not you only. Further, as a gesture of goodwill, we humans will make December 31 as the WORLD CORONA DAY (the first death due to COVID-19 occurred on December 31, 2019 in Wuhan, China). So, Miss Corona, be benevolent and let the human race exist. Kindly retreat.And finally, we have one more request, Miss Corona. Please don't get married. When you marry someone in your community of vicious viruses, you may beget children with treacherous genomes which may wipe out the remaining 40% of the world population, faster than by you -- one Chinese billionaire in the US estimated that 60% of the global population would vanish because of you.
Postscript:
It may not be palatable to you, Miss Corona, but let me tell you this. You had indeed killed around 100 thousand in the rich Western countries, but you couldn't do much havoc in the Indian subcontinent and the African continent, despite our lower standards of living, personal hygiene, sanitation, education, environment and medical facilities. And add to that, our not praiseworthy habits and beliefs -- some of us are not touching newspapers and drinking cow's urine to ward you off ! Hot climate may not be the only factor, as some countries in the tropical zone are also badly affected by you. In India, of the size of 1.3 billion people, you could infect only around 19,000 people and kill only around 600, as on 22.04.2020. You know why ? Lower standards are a blessing in disguise for us.
Our environment is full of filth, bacteria and viruses. So, we had a lot of subclinical (not very symptomatic and not compelling to see a doctor) infections which generated immunity (resistance) -- like racial or herd immunity, over a period of decades and centuries. Lower resistance in western societies may curiously be due to over-sanitisation (too much of cleanliness and hygiene). If a little is good, a lot need necessarily not be better. This concept may seem strange and unacceptable, but this view may be vindicated by 'post-corona' epidemiological studies.
If you go a little back into the history of science, you may think of Darwin's theory of evolution - natural elimination of the weakest and survival of the fittest. One telling example is this: Dharavi in Mumbai is the Asia's largest slum. 15 lakh people live on the little space of 613 hectares with no proper ventilation, sanitation, light and other basic facilities like water. In the normal thinking, any infection like coronavirus in this slum would infect the entire Mumbai in no time. Earlier, a decade ago, when swine flu struck India, hardly any case was detected in this slum while around 3,000 people died in the country. Some researchers and Satish Pawar, Director of Maharashtra Health Mission said that the immunity of the population in this slum is robust which may explain this paradox. Hence, Miss Corona, don't touch us, we are resistant and may retaliate brutally. And we have the unique miRNA, 'has-miR-27b' armour !
Yours truly,
T. Rama Prasad.
--------------------------------------------------------------------------------------------------------
Miss Corona
Dear Rama Prasad,
Your saviour,Yours is the first ever letter I received in my life. I am a lifeless RNA particle, though. Thank you. I understand the anguish and the anger of the Homo sapiens. You humans seem to have misunderstood me totally. Dear Prasad, I want to make it very clear. I didn't come here to kill you all. In fact, I love Mahatma Gandhi, an advocate of 'ahimsa'. I just want to teach you all a lesson.
Why are we coming out of our cosy caves and pristine jungles ? Because you incomprehensible humans caused an ecological imbalance through thoughtless tinkering with nature -- invaded our forests, destroyed them, forced animals along with us (viruses) to come out of the forests, polluted the planet, caused global warming, etc. Stupids to the core you are. You are killing the hen that is laying golden eggs. And you have all changed your lifestyle to the worst with scant regard for good old habits ... lost the sense of values ... and you Indian sheep embraced the bad of the western culture -- shaking hands, hugging and kissing everybody, devouring junk food ... good, not yet using toilet paper instead of water. Anything 'modern', you are hooked by, moral or immoral.
You mortals are all intelligent idiots ... used your intelligence to become affluent, arrogant, adamant, angry, egoistic, and inhuman ... used your idiocy to materialistically overexploit nature and fiercely fight among yourselves, even using us (microbes) in your warfare. You are all abysmally cruel and brutal not only to your neighbours but also to all other creatures ... look at your abattoirs where you slaughter millions mercilessly under the eerie veil of kind words like 'humane killing'. Appalling. What a treacherous lot you are ! Nature is not your inherited property to sap it to please your perverted tastes and crazy senses.
Don't arrogate with your sense of supreme intelligence and blindly believe that you can prevent and cure diseases with vaccines and drugs. I had exposed your hollowness. Flames of my fury devoured your firewalls ! What could those highly empowered fatty western countries with impeccable health infrastructure could do when I unleashed my might ? Scurrying around like headless chicken ? I upended their comfort zone. I challenged their certitudes. I did kill brazenly, unlike you timid tots who do it clandestinely. Prasad, I am killing only to save you all and the remaining life on this planet, by forcing your selfish selves to live sensibly, sensitively and humanely. Shed hypocrisy, megalomania and one-upmanship. Be human. But you are not humans, you are the vicious viruses of all time, full of soulless greed, distilled selfishness and insatiable corruption.
You are notorious not to learn lessons. Earlier, my cousins (SARS, MERS, EBOLA, NIPAH, H1N1, et al) came to discipline you, but in vein. That's why I had to step in. I don't trust you, incorrigible humans. Once the 'LOCKDOWN'' is over, you clever and stupid fellows would get back into the 'BUSINESS AS USUAL' mode. That's why I may extend my stay for some more time until you are mellowed, tamed, tuned and detoxified. And imagine your misery when I extend the 'personal distance' to 10 metres ! You need to wash your brains, not just hands.
Postscript:
Why are we coming out of our cosy caves and pristine jungles ? Because you incomprehensible humans caused an ecological imbalance through thoughtless tinkering with nature -- invaded our forests, destroyed them, forced animals along with us (viruses) to come out of the forests, polluted the planet, caused global warming, etc. Stupids to the core you are. You are killing the hen that is laying golden eggs. And you have all changed your lifestyle to the worst with scant regard for good old habits ... lost the sense of values ... and you Indian sheep embraced the bad of the western culture -- shaking hands, hugging and kissing everybody, devouring junk food ... good, not yet using toilet paper instead of water. Anything 'modern', you are hooked by, moral or immoral.
You mortals are all intelligent idiots ... used your intelligence to become affluent, arrogant, adamant, angry, egoistic, and inhuman ... used your idiocy to materialistically overexploit nature and fiercely fight among yourselves, even using us (microbes) in your warfare. You are all abysmally cruel and brutal not only to your neighbours but also to all other creatures ... look at your abattoirs where you slaughter millions mercilessly under the eerie veil of kind words like 'humane killing'. Appalling. What a treacherous lot you are ! Nature is not your inherited property to sap it to please your perverted tastes and crazy senses.
Don't arrogate with your sense of supreme intelligence and blindly believe that you can prevent and cure diseases with vaccines and drugs. I had exposed your hollowness. Flames of my fury devoured your firewalls ! What could those highly empowered fatty western countries with impeccable health infrastructure could do when I unleashed my might ? Scurrying around like headless chicken ? I upended their comfort zone. I challenged their certitudes. I did kill brazenly, unlike you timid tots who do it clandestinely. Prasad, I am killing only to save you all and the remaining life on this planet, by forcing your selfish selves to live sensibly, sensitively and humanely. Shed hypocrisy, megalomania and one-upmanship. Be human. But you are not humans, you are the vicious viruses of all time, full of soulless greed, distilled selfishness and insatiable corruption.
You are notorious not to learn lessons. Earlier, my cousins (SARS, MERS, EBOLA, NIPAH, H1N1, et al) came to discipline you, but in vein. That's why I had to step in. I don't trust you, incorrigible humans. Once the 'LOCKDOWN'' is over, you clever and stupid fellows would get back into the 'BUSINESS AS USUAL' mode. That's why I may extend my stay for some more time until you are mellowed, tamed, tuned and detoxified. And imagine your misery when I extend the 'personal distance' to 10 metres ! You need to wash your brains, not just hands.
Postscript:
And, Prasad, I would like to tell you mortal fellows (I am not mortal because I don't have life) one more thing. Do you all really believe in your own science and researchers ? Some of the very ICMR scientists who approved the LOCKDOWN in India wrote in a research paper earlier that the measure could lead to "long-lasting adverse health outcomes" (Indian Journal for Medical Research) ! They further projected that "community and civil-society-led self-quarantine and self-monitoring" is better than "coercive top-down quarantine approaches, which are driven by the authorities." And I read the news that research studies in Wuhan revealed that false negative reports on coronavirus diagnostic tests could be as high as 30% ! ... British Prime Minister is in ICU and Uncle Sam is fuming at WHO and halted funding it. You are all good at blame game. You are all uncertain Lilliputians in virology ... I can sweep you all off the planet in one stroke. However, Prasad, tell your Indians that I have a soft corner for them ... look at the figures, I didn't do much harm despite their vulnerable and creaky health care system.
Miss Corona.
----------------------------------------------------------------------------------------------------------
CORONA NOVEL MASK N-195
Buy one bra & get one mask worth Rs.195 free
Limited edition offer, hurry up !
----------------------------------------------------------------
The world has entered unchartered territory in its battle against the deadly coronavirus.
-----------------------------------------------------------------
Buy one bra & get one mask worth Rs.195 free
Limited edition offer, hurry up !
----------------------------------------------------------------
The world has entered unchartered territory in its battle against the deadly coronavirus.
-----------------------------------------------------------------
It is shocking and surprising to see such a surge in the most empowered country. As on 09.05.2020, the figures are given below. The impact is low in India whose strength to combat the disease is not comparable to the US. Is it due to the several factors I mentioned below or due to gross under testing and underreporting ? The difference wouldn't be so much even if it was 'gross', especially considering the population ratio.
UNANSWERED QUESTIONS
1. Why is the 'Corona Impact' so much in America (Cases: 21 lakhs; Deaths: 116 thousand; Population: 0.3 billion; Deaths per lakh of population: 29; Health infrastructure: Top-notch, with around 20% of GDP and 19 trillion dollar economy), and so little in India (Cases: 3 lakhs; Deaths: 8 thousand; Population: 1.3 billion; Deaths per lakh of population: 0.3; Health infrastructure: Not praiseworthy, with just around 1% of GDP of Rs 200 lakh crores), as on June 13, 2020 ?
2. Should we revisit the pandemic and revise our theories ?
3. When will we get rid of this pan-global problem ?
The first question may be answered this way: If we have 'EXIT' polls for India (like that for elections) scripted by epidemiological experts, most of them would have predicted macabre deaths as was of the 'Spanish Flu' of 1918 or the 'Bubonic Plague' of 1855 (10 million deaths in India). It just didn't happen -- didn't even of a minute fraction of it. Why ?
Some hypothetical factors are:
(1) Strict and timely 'Lockdown' in India (2) Bad hygiene in India leading to high 'herd immunity' by virtue of subclinical infections (3) Low allergy in Indians resulting in low 'cytokine storms' (4) Hot weather in India not being favourable to the virus (5) The weak virus reaching India a bit late after multiple conservative mutations abroad (6) Low international travel to and fro India (7) More broad spectrum immunity of Indians due to various infections as some viral protein features are shared with other microbes and parasites through multiple mechanisms of celllular ingress and proliferation (8) Racial herd immunity acquired through a series of a multitude of infections / mutations and polymorphisms over millennia and passed on through Indian generations of cellular receptors (9) Younger population is higher in India who have higher immunity and are not hyper-prone to allergy, perhaps, due to lack of 'western-type-of-oversanitisation' (10) America's junk food and unhealthy lifestyle, indirectly and directly, made them vulnerable (read the two LINKS given below) (11) Almost all Indians (and almost none in America) had BCG vaccination which may confer antiviral immunity / 'trained immunity'. (12) Some allergy and pollution related lung diseases like asthma and COPD have a higher presence in the Western societies (13) Like Nipah virus, this virus also may have called it a day in India !
These 13 factors are not listed according to the importance, as no one knows certainly about this game. Some may put the first factor (Lockdown) at the bottom also.
There is another unanswered question: Why is the Case Fatality Rate (CFR) is low (around 3%) in India, and why there is a lot of disparity of CFR among the various States -- Tamil Nadu, the third worst-hit State ... 0.7%; West Bengal, the number 8 in case load ... 9% (as on 19.05.2020) ?
WESTERN is MODERN
1. America's Junk food ... coronavirus https://nypost.com/2020/04/18/americas-junk-food-diet-makes-us-more-vulnerable-to-coronavirus/
2. Fast food and Immunity ... https://www.sciencedaily.com/releases/2018/01/180111141637.htm
The article cited above (America's junk food), with statements by Dr. Nicole Saphier, MD, a radiologist at New York's Memorial Sloan Kettering Cancer Center makes the following home truths come to the surface:
Indian poverty is a blessing in disguise. The Western affluence is a killer in disguise. The root cause for the West's metabolic bad health, their vulnerability to corona fatalities and the enormous public and private medical expenditure may lie in their bad life style, food habits, culture and commercialism, in general. The bad commercialism is such a priority that most of the stakeholders (including doctors and researchers) channelise their energy and resources to develop more drugs, more vaccines, more diagnostic novelties, more medical and surgical equipment, more sophisticated hospitals, more bizarre dietary supplements, more endos and echos, more 'evidence-based' diagnostic and treatment protocols (cleverly designed money-making formats), more health insurance business and making more money rather than to prevent diseases, metabolic and infective, in the world.
And in the process of making money, nature was destroyed (near home and far in the forests, all over the world) leading to more diseases ... more business ... and more destruction. If humans promote good life style , good health and better environment, all these gigantic commercial enterprises would collapse. Ill-health sustains the multi billion dollar 'Medical Industry' which countries can't afford to lose. The US alone spends about $2 trillion on diseases caused, directly or indirectly, by bad life style. This business would be lost if people live right. The stakeholders are numerous -- individuals to industries. The 'bad-food industry' and the 'bad-entertainment industry' help the 'bad-medical industry' by ruining the people's health. Shrewd business. Pseudoscientific industry lures the gullible public with various health gadgets, including 'Oxygen Parlours'. And one wondered why sunlight and disinfectants can't be injected to prevent corona !
In general, the Westerners are good, hardworking, talented and jolly people. But they have their own philosophy, habits, tastes, culture, morality and weaknesses. They seem to crave for immense and instant pleasure to their five senses which their wealth can easily buy ... why worry now about future health, we have world class medical facilities and all the wealth in the world to pay for them ... let's take life easy, go around the world holidaying, devouring and drinking ... enjoy -- the animalistic doctrine of "Work - Consume - Die", dressed in subtle and gross deceptions. That seems to be the thinking in 'The Land of Free' and 'The Lands of Plenty'. They may hate to be disciplined and love to be arrogant. Otherwise, how were we threatened of 'retaliation' if we didn't supply 'hydroxychloroquine' tablets immediately ? And naturally their children were brought up on the same lines.
The tragic spillover of the Western life style is that some of our wealthy, fussy and food-centric 'pseudo-western-Indians' have been embracing the Western way of eating and living as a status symbol and getting ruined -- aping the Western tastes ... processed foods, packaged foods, pizzas, pastas, burgers, cookies, rolls, colas, avocado, zuccotto, corona beer, E-cigarettes, McDonalds, KFCs, etc. ... all status symbols ... hypocrisy. They cultivated an exalted and dizzy feeling of superiority over the 'rubbish folk of Indian lifestyle and culture' !!! If you live the life right, you may as well forget the three Ds -- Diseases, Doctors and Drugs !
Most of the corona deaths are associated with co-morbid conditions like diabetes, heart disease, metabolic diseases, obesity, etcetera. These are all related to a great extent to the food habits which Dr. Nicole Saphier mentioned in the above article.
AMERICAN RECKLESSNESS or WISDOM ?
On June 20, 2020, a political rally was conducted in Tulsa, Oklahoma, US at an indoor accommodation of 19,000 seats where most of the attendees, including the President of the US who addressed the gathering, didn't wear masks while the Coronavirus was spreading and killing fast (2.2 million cases and 1,20,000 deaths). And Trump said at the meeting that the "bad aspect" of virus testing is logging more cases.
Moreover, a series of meetings were planned on June 23, 2020 including the one at the Dream City Church of 3,000-seat capacity in Arizona with the participation of the US President. Wearing of masks is optional. Arizona, Florida and Texas or hotspots for Corona and have Republican Governors who are said to be bullish on reopening businesses.
"The appearance, at the Dream City megachurch, was one of his first rallies since taking a three-month hiatus because of the coronavirus pandemic. Images from the event showed a large crowd tightly packed together, with almost no one wearing protective masks. There were no temperature checks for the estimated 3,000 cheering attendees who, like many of Trump’s staunchest fans, ignored a new local ordinance requiring them to wear a mask, despite a public-health plea from the Democratic mayor on Monday." There were 3,591 new cases and 42 deaths on that day, and Trump made fun of coronavirus at the meeting.
https://www.politico.com/news/2020/06/23/trump-rally-arizona-336565 .
 |
| AT TULSA RALLY |
"The appearance, at the Dream City megachurch, was one of his first rallies since taking a three-month hiatus because of the coronavirus pandemic. Images from the event showed a large crowd tightly packed together, with almost no one wearing protective masks. There were no temperature checks for the estimated 3,000 cheering attendees who, like many of Trump’s staunchest fans, ignored a new local ordinance requiring them to wear a mask, despite a public-health plea from the Democratic mayor on Monday." There were 3,591 new cases and 42 deaths on that day, and Trump made fun of coronavirus at the meeting.
https://www.politico.com/news/2020/06/23/trump-rally-arizona-336565 .
 |
| AMERICA -- "The Land of the Free" On July 1, 2020, Anthony Fauci, infectious disease expert and the leading member of President Donald Trump's coronavirus task force said: "The number of cases could go up to 100,000 per day if authorities and the public fail to take steps to suppress the pandemic ... Americans should wear masks and avoid crowds and mend lax behaviour ... I'm very concerned and I'm not satisfied with what's going on, because we're going in the wrong direction."  The LAND of the FREE While the medical head of that land said so, the administrative head ventilated about the freedom. They are at loggerheads. 'Uncle Sam' assured that the citizens will have the freedom to choose between 'mask' or 'no mask', in 'the land of the free'. Wisdom and science of the POTUS !!! |
INDIAN IMMUNITY and BCG VACCINATION
April 1, 2020
You are an Indian and you had BCG vaccination. And you had grown up amidst filth and germs. So, you may be immune to COVID-19.
No, it's not an APRIL FOOL'S DAY joke. COVID-19 has spread to most countries across the globe. Puzzlingly, the impact of the disease is different in different countries. Why ? We don't exactly know. Cultural norms, climate, affluence, empowerment, infrastructure, mitigation efforts, etcetera are cited as possible reasons for the differences. Two more factors may be added on the strength of very recent studies. 1. Indian immunity. 2. BCG vaccination
1. INDIAN IMMUNITY:
Our environment is full of filth, bacteria and viruses. So, we had a lot of subclinical (not very symptomatic and not compelling to see a doctor) infections which generated immunity (resistance) -- like racial or herd immunity, over a period of decades and centuries. Lower resistance in western societies may curiously be due to over sanitisation (too much of cleanliness and hygiene). If a little is good, a lot need necessarily not be better. This concept may seem strange and unacceptable, but this view may be vindicated by 'post-corona' epidemiological studies.
We all have thousands of microbes in our bodies which may not produce disease because of our immunity. And, in course of time, we may naturally gain immunity, called ‘herd immunity’, to this coronavirus also, through sub-clinical infections. When around 65% of the population has antibodies, presumably due to infection (asymptomatic or symptomatic), it may be assumed that the population has gained herd immunity. As on August 20, 2020, we have the jaw-dropping sero-survey results -- 57% in Mumbai slums, 51% in some areas in Pune. The Delhi sero-survey findings published in July 2020 indicate that a whopping 50 lakh people (28%) have already developed 'herd immunity' through 'silent infection', while only 100,000 cases were detected through RT-PCR testing, in Delhi (1 in 50). The virus is spreading unevenly with different timelines in different regions. So far, nationwide, 27.6 lakh (0.2% of India's population) cases were detected and around 53,000 died (August 20, 2020).
Perhaps, because of better ‘India-specific’ racial immunity passed on through generations of cellular immunity and ‘memory T cells’, the ‘Case Fatality Rate’ has not been high in India, despite our creaky, rickety and shambolic health care systems. This is a sliver of silver lining for us. Moreover, there is evidence to say that SARS-CoV-2 - specific memory T cells are found in infected persons with or without symptoms -- even in those who did not develop antibodies (seronegative). Memory T cells confer certain degree of adaptive immunity which may be longer-lasting than that with antibodies.
In addition, the following is the authentic information about it. A recent study of an integrated sequence-based analysis of COVID-19 genomes from different countries yielded interesting findings
The phylogeny of the genomes also makes it evident that a unique mutation in the spike surface glycoprotein (A930V - 2435 C>T) is present in the Indian sequence. Any variation in the immunity or response to treatment may be due to this 'India-specific' difference. COVID-19 genomes, host-virus interaction and pathogenesis may vary from country to country (https://doi.org/10.1101/2020.03.21.001586).
COVID-19-specific Memory T cells
Many people all over the world are exposed to four different coronaviruses that cause 'common cold'. The common cold infections produce what are called 'Memory T cells' or 'Memory CD4 T cells' or 'Memory Helper T cells' or 'pre-existing cross-reactive memory T cells'. These memory T cells may confer some immunity against SARS-CoV-2 also. This is called 'Pre-existing immunity' in individuals who were never exposed to SARS-CoV-2. It may be possible that Indians have more of these cells which reduce the severity and death rate of COVID-19. In one study (La Jolla Institute for Immunology, California) it was found that 28% of healthy blood donors were found to have the pre-existing cross-reactive memory T cells against spike or membrane proteins of SARS-CoV-2. The pre-existing cross-reactive memory T cells might be from previous exposures to common cold coronaviruses. This is an unanticipated degree of 'population-level immunity' against COVID-19. It may be more in the Indian population.
MUTATIONS
The coronavirus keeps changing through mutations. The SARS-CoV-2 that is present in India may not be the same as the one that caused the first case in China. There are at least six identified strains of the virus in circulation across the globe (these are usually referred to as 'strains' or 'mutants', but, they should more appropriately be called as 'lineages' or 'clades' or subtypes'). Ten lineages have evolved from the ancestral type --the Wuhan virus type. Based on the revised time-stamped nomenclature, there are now (Aug 2020) 5 lineages -- 19A, 19B, 20A, 20B and 20C. The lineages 20A, 20B and 20C all have the D614G mutation. The D614G lineages have become dominant in India -- 20A in northern and Eastern; 20B in southern and western. The D614G mutant viruses are super-rapid spreaders, but not very lethal. They are very dominant in Europe and North America but not so much in East Asia. They go on mutating. Some are not effective and die out. Some may become more virulent. While the G strain is the most common (which dominated the earlier D strain after March 2020), some have vanished. As in August 2020, a swap between amino acids, identified as D and G, at position 614 in the code of the virus's spike protein produced a variant mutant called D614G which is currently the dominant strain worldwide. The strains present in the IUS are similar to those in Europe, perhaps due to the travel factor. In Indioa, the first coronavirus was the L strain originating in Wuhan, which eventually mutated into the S and G strains and spread all over the country. Due to closing of borders between States during the lockdown period, different types of mutations might have occured in different States. The Malaysian case from Tamil Nadu raises the possibility of the D614G strain being in Tamil Nadu. A particular vaccine developed may or may not be very effective against a different mutant. 'An effective vaccine must be against the entire diversity of the virus'. Some say that not giving a vaccine is better than giving a partially effective vaccine. For more about this virus read under the subheading "What is this virus about ?" on this page below.
2. BCG VACCINATION:
Bacillus Calmette Guerin (BCG) vaccine comprises of one kind of live but weakened (attenuated) tuberculosis (TB) bacilli usually given to infants to protect them against some forms (like military and meningeal) of TB. You may be wondering: "What's the connection between BCG and COVID-19 ?" Most surprising is the assumption that BCG vaccination might have protected the countries where BCG vaccination is in general use - protection from COVID-19, though BCG is meant for protection against tuberculosis (TB). The assumption arises out of scientific studies (New York Institute of Technology, USA). In a study (University of Texas, Houston) covering 178 countries, it is found that death rates due to coronavirus are lower by a factor of 10 in countries that had a strong BCG vaccination regimens. It is found that morbidity and mortality due to COVID-19 are high in countries where BCG vaccination is not in practice universally (Spain, Italy, France, USA, etc.). The COVID-19 didn't affect much the countries where BCG vaccination is given soon after birth universally since a very long time (India, Japan, etc.). Death rates are low even when infection rates are moderate in Malaysia, Ireland, the Czech Republic, the Slovak Republic, Hungary, Costa Rica, India and many other nations which have strong BCG programmes. All the same, Germany, Norway and Denmark have low death rates though they didn't have BCG cover. Interestingly, within Germany, the former East German part which had strong BCG regimen has now a lower rate of mortality due to coronavirus. There seems to be good correlation.
What has bacterial TB vaccine to do with viral COVID-19 ? Most of the Indians had BCG which may confer immunity against many bacteria and viruses. Hence, perhaps, the death rate due to COVID-19 is low in India.
Almost all of us in India were given BCG vaccination (from 1948 onwards) soon after birth to prevent some forms of TB. We seem to be lucky that we may have some immunity against coronavirus also, unexpectedly. BCG vaccination significantly increases the secretion of pro-inflammatory cytokines, specifically IL-1B which has been shown to play a vital role in 'antiviral immunity' - 'trained immunity'. And, BCG vaccination has been reported to offer broad spectrum protection against respiratory infections. Thus, the BCG protection might influence the morbidity and mortality due to COVID-19 by protecting people from co-occurring infections and sepsis which ultimately kill (https://doi.org/co.1101/2020.03.24.20042973). A photocopy of an editorial published 40 years ago in a medical journal wherein my opinion on BCG vaccination was mentioned is attached below.
BCG has been one of the most successful immunotherapies since 1977. It has been in use for bladder cancer. It may also be useful in colorectal cancer, leprosy and Buruli ulcer. It may non-specifically reduce mortality in low-income countries and reduce other health problems including sepsis and respiratory infections, when given early in life. Some are studying its effect on Type 1 diabetes. BCG vaccine is in Phase-3 trials (as of March, 2020) in studies to prevent COVID-19 in health care workers in Australia and Netherlands. Neither country practises routine BCG vaccination.
All this does not mean that BCG can be used as a vaccine or preventive against COVID-19. It only means that this preliminary analysis of data indicate that one of the several factors accountable for the variation of morbidity and mortality among several countries may be the BCG factor. A lot of research is to be conducted before any conclusive evidence can be put forth on this matter.
On July 13, 2020, a BCG study trial is initiated to evaluate the effect of BCG in preventing or modifying COVID-19 in the age group of 60 to 95 years at the National Institute for Reseach in Tuberculosis (NIRT) at Chetpet, Chennai under the auspices of the Indian Council of Medical Research (ICMR). Five more centres are chosen for this study in Gujarat, Rajasthan, Madhya Pradesh, Maharashtra and Delhi. 3. Subclinical TUBERCULOSIS infection may also act like BCG vaccination. In India, tuberculosis germs are present in the air that is breathed in. In most of the people they don't cause disease but may increase the immunity. This may be one of the reasons for the low mortality in India due to COVID-19. It should be studied to validate this reasoning.
4. GENETIC FACTORS
There may be individual genetic factors which may influence contracting the disease or the severity of the disease. For example, variants of the gene TLR7 along with defects in the production of immune system molecules type I and type II interferons may influence immune response, susceptibility to the virus and the vulnerability to 'cytokine storm' (
FEAR and POVERTY PSYCHOSIS
The greatest damage that this pandemic did and will do is of infusing FEAR into our blood through media. The 'INFODEMIC' is the real pandemic destroying health and economy through FEAR which leads to frightening thoughts and disastrous interventions. We are drowned and suffocated with information, misinformation and fake information. Fear, fear and fear. Fear makes one mad.
When it is said that a normal person without any symptoms can potentially transmit this deadly virus through normal breathing, how can one be without fear ?
Doctor is afraid of seeing a patient. Patient is afraid of being tested. Everybody is afraid of quarantine and social stigma. Homemaker is afraid of a housemaid. Maid is afraid of a coughing child in the house. Employee is scared of going for work. Employer is worried about closure of his factory if an employee tests positive. One is scared of touching a newspaper. Another is afraid of using sugar without washing it ! We are afraid of each other. What life is this ?
 |
| Remedy seems to be worse than the malady |
Already many of the diseases in the 'modern' world are due to stress. Now, Covid is adding fuel to the fire, immensely enhancing the fear of the virus and the fear of loss of livelihood. Tension and stress lead to mental illnesses which in turn lead to physical illnesses. Fear destroys immunity and stress kills. Sooner and later, directly and indirectly, there could be enormous morbidity and mortality due to fear and stress, much more than that due to the virus illness. The impact would be more due to the fear of losing life and the stress of economic crush / crash / crunch, consequent to the ongoing disruptions in supply and production across the world. Uncertainty of everything is the greatest stress.
Mental health issues of 'migrant workers' is a special problem in India. Enormous number of the workers had to return to their home States due to the 'lockdown'. They have no means of sustenance. Many of them became so mentally ill that they attempted suicide. Uttar Pradesh alone has 35 lakh migrant workers who have returned jobless. Out of them, 37,681 workers were given "Psychological Support"through the partnership of the UNICEF. A study conducted by Indian Psychiatry Society found that there has been an almost 20%rise in mental health issues during the pandemic.
FEAR is both good and bad. Excessive fear destroyed the economy and mental health through 'lockdowns'. Lack of fear spread the virus by not observing preventive measures. If it is 'unlocked' a bit, people are going about as though the virus is absent. If you behave like the UNWISE MONKEY, you will be totally 'caged' again !!!CORONA and MIND HEALTH
Beggar to billionaire -- all seem to have been stressed mentally by corona. Mind may also be affected in the monumental 'Corona Crisis'. The psychological impact looms large all over the world. According to a survey (Aug 2020) by the International Labour Organisation (ILO), due to this pandemic, 50% of the young people across the world may have anxiety or depression and 17% of them may need therapy.
Even long after the pandemic is controlled (don't dream of eradication, it is likely to be a permanent unwanted guest), the psychological and psychiatric fallout of this disaster may linger on for decades. Already, there are seismic psychological pressures threatening American society. The present crippling of big-box retailers and mom and pop shops worldwide is making a dent on mental health. Reports of related suicides are seen.
https://timesofindia.indiatimes.com/blogs/toi-editorials/fear-and-trembling-sushant-singh-rajputs-tragedy-speaks-to-the-wider-mental-health-challenge-of-covid-times/
Scientific studies have shown that isolation from people coupled with economic deprivation and deaths leads to psychological distress, anxiety, tension and depression. Fear and helplessness brought about by loss of income and jobs are common factors affecting the mental health of most people. It may manifest as "Post-traumatic Stress Disorder (PTSD)", Anxiety Neurosis, Panic Reactions, Psychosis, Stress Dementia, Delirium, Nightmares, Paranoia, suicidal tendency, etc. Further, the societal attitude towards the corona patients would be stigmatising and traumatising. And the longer the one is isolated from normal life, the more disrupted is the mind. A host of negative feelings creep in with economic slide down. Added to this is the time bomb -- "people with no symptoms may also transmit the virus" ... this information is enough to kill ... stress kills.
DOCTORS are no exception. In just two months (July - August 2020) 11 suicides by doctors in India have been reported. Even in the pre-corona period, many of the Indian doctors had mental problems (30% - depression; 16.7% - suicidal ideas; 90% - burnout feelings), a study by the PGMIER, Chandigarh shown in 2018. The increased mental morbidity among doctors may be due to professional stress, competition, jealousy, strained relationships with colleagues, high bar of goals, high expectations from relatives, high investment with low returns coupled with low service-mindedness, etc.
One psychiatrist said: "It's normal in corona days if one talks to walls, trees and animals. But if they talk back to him, he needs my therapy."
OTHER DISEASES easily pounce on the bodies of a vulnerable mind. Perhaps, more damage to health and more deaths, than usual, would follow due to diseases other than COVID-19. Uncertainties and vicissitudes in life trigger vulnerabilities, as also solitude. Many of the existing diseases are due to the stress of 'modern life' and are preventable if changes in 'lifestyle' are made.
IN INDIA, the fallout of psychiatric disturbances may be less due to the better attachment to family members and the society around in contrast to the western societies. The resilience quotient of Indians is very high. The devastating derangement caused by the coronavirus in western countries is already making their folk run to shrinks for therapy.
Once, somebody asked Bhagwan Buddha: “I want happiness. What should I do ?” Buddha smiled and said: “It is very simple. ‘I’ stands for ‘ego’ – give it up. ‘want’ stands for ‘desire’ – give it up. Then, what remains in your ‘I want happiness’ is pure ‘happiness’!” --------------------------------------------------------------------------------------------
IMMEDIATE BENEFITS of corona and lockdowns
(for most of the people around the world, for a short 'home picnic' period of a few weeks !)
1. Steep fall in Traffic Accidents
2. Less air and noise pollution
3. Least political pollution
4. Strikes and dharnas vanished
5. More sleep and less exhaustion
6. Less arrogance and more aggressiveness
7. More realism and less hypocrisy
8. Less materialism and more morality
9. More introspection and less ego
10. Less crime, violence and fighting
11. More home food, less junk food
12. High level personal hygiene
13. Less drug consumption
14. Less hospital bills and reimbursements
15. Surplus water and electricity
16. More savings for salaried people
17. Surplus time, more time with family
18. Leisurely routine, less stress in life
19. Work from home convenience
20. More sympathy and empathy
21. More humaneness and less cruelty
22. Less animalistic behaviour
23. More discipline and values in life
24. Less corruption, more transparency
25. Less expenditure for people
26. Less war and more philanthropy
27. Less hatred and more love
28. Realisation that we are smaller than virus
29. Awareness that money can't buy everything
30. Preparedness to leave the planet any moment
Thank you, Miss Corona, for the benefits to the Homo sapiens. But, once you leave, we may get into the "BUSINESS AS USUAL" mode ! ......Dr. T. Rama Prasad
BENEFIT from OFFICE ! BENEFIT of GAIN !
"You had learnt to live with wife / husband. Now learn to live with Mrs. / Mr. Corona also. Because you are wedded to both and can't divorce !"
-- T. Rama Prasad. For more quotes, click on: https://drtramaprasad.blogspot.com/2017/06/quotes.html
June 18 : "International Picnic Day. Yes, it was like a PICNIC INSIDE HOME for 3 weeks from March 25, 2020. But later, the SWEET PICNIC turned into a BITTER BORE for many. Now on, a picnic can be had outside the home, but it won't be the same. The good old halcyon days have well and truly come to an end with the uncertainty of a truly safe and effective vaccine." -- T. Rama Prasad
COVID-19
In 1855, 'Bubonic Plague' pandemic swept the world and rapidly killed 10 million people in British India. The epicentre of the outbreak was also in China -- a place called Yunnan. Later in 1918, the Spanish flu swept the world from Kansas to China ... perhaps, it didn't start in Spain though it's named so -- it might have started in the US Army / Navy, perhaps, the news was played down in those days of war, jingoism, censorship and denial. The Spanish Flu killed as many as two crore Indians.
COVID-19 is a new virus which started its journey in China (Wuhan) in December 2019 and spread fast and wide to 210 countries / territories across the world within a short period of less than five months, https://www.verywellhealth.com/difference-between-epidemic-and-pandemic-2615168 ). It's a humongous task to deal with. Nearly100,000 were killed eclipsing the death toll of 774 of the global outbreak of SARS that also started in China. The future course of the disease is very unpredictable, with the unexpectedly devastating spread to many countries.
The WHO has renamed the virus as COVID-19, and declared this virus as 'Public Enemy Number One' which holds a grave threat to the entire world. 242 people died on a single day on 12.02.2020 in China and 793 on 21.03.2020 in Italy. The WHO had mandated all the countries to be "as aggressive as possible" in fighting the COVID-19.
The following are the links to my 'scribblings' on some other viruses:
KILLED DOCTORS and MEDICAL WORKERS TOO
Dr. Li Wenliang who posted early warnings of the presence of this virus on his social media group (considered to be an offence and punishable by the local authorities) died due to infection by the same virus ! Dr. Liu Zhiming, the Director of Wuhan Wuchang Hospital and an expert in Neurosurgery, died on February 11, 2020 due to this virus. More than 1,700 medical workers were infected, and six of them died as on 20.02.2020. Most medical staff in Wuhan are said to be infected by this virus. In Italy, more than 100 doctors died of this disease. More than this number of doctors (more than 200) died in India too.
Infected doctors seem to have a 10-12% risk of mortality. This is due to exposure to a HIGHER VIRUS LOAD, which leads to a 'cytokine storm'. People, in general, are usually infected through air and contacts or fomites (infected surfaces). Fomites have a lower virus load, and hence a lower mortality rate of about 2-3%. Doctors attending on the COVID-19 patients, pulmonologists, intensive care specialists anaesthetists and also the staff attending on these patients are at higher risk. The nurses (20%) and sanitation staff (30%) seem to have a higher risk of mortality.
We don't know how the virus came to France, but a study published in the International Journal of Microbial Agents indicates that an old sample of one patient (Mr. Amirouche Hammar) treated in December 2019 was positive for the coronavirus. He lived in France with no recent travel history.
" ... CORONA FLOWERS: Physically, coronavirus, looks like a ball of sun with a circle of corona of spikes -- thus derives its name. We identified 3 kinds of flowers which are 'lookalikes' of coronavirus -- (1) Haemanthus / Scadoxus multiflorus (2) Sphaeranthus indicus (3) Memecylon edule !!! -- Mrs. V.S. Rajyalakshmi, M Sc (Botany) & Dr. T. Rama Prasad. ..."
PETS and CORONA
We may have to go back to 12,000 years ago, when our ancestors settled down at various locations alongside rivers and lived with agriculture and a few domestic animals. We don't know whether those animals had viruses or not, but the animals and birds we brought in from deep jungles do have dangerous microbes. Some of them are mentioned below. The fashion is to talk about new diseases while ignoring old diseases which cause more economic damage and kill more number of people. Tuberculosis (TB) is an example.
The "CHINA VIRUS" is still wreaking havoc in China. Perhaps, their products made for home consumption may be of lasting quality ! Yes, they have the capability to produce cheap quality firecrackers and sophisticated space rockets as well. Otherwise, how could they build a 1,000-bed hospital in nine days for Coronavirus patients ? Kudos to China.
FAKE INFORMATION
No other disease had generated so much of fake news, rumours and misinformation than Coronavirus COVID-19. Honestly speaking, we don't have much of proven facts about this disease. This is the exact reason for the great bulk of misinformation about it on the Internet. While the scientific world is struggling to find facts about this new virus, innumerable preventive and curative suggestions are made with no scientific proof. Millions of dollars are being spent on products of unproved efficacy. During the past one month, you would have seen innumerable suggestions of "eat this" and "don't eat this" on the Net. Tall claims were made by alternative systems of medicine, though with no verifiable scientific proof. Many of the suggested food items or medicinal supplements may, of course, boost immunity in a general way -- but nothing very specific to this virus. And some of the misinformation lead to a needless scare about certain things like newspapers, chicken, etc. And it also promoted some drugs, vitamins, minerals, cow's urine, tea, bananas, etc. as preventive agents against COVID-19.
About 770,000 die of AIDS and related illnesses, and 1.35 million die of road accidents every year around the world. Every year around 5 lakhs of people die in the world due to 'flu' (seasonal influenza) viruses, around a thousand a day. ... When we get used to the trouble they give chronically, we tend not to think much about them. Our brain gets set to take them as normal.
Don't get panicked about Miss Corona who killed only around 100,000 in the whole world so far (10.04.2020), but the fear of an invisible enemy in the very air that we breathe is primal. It is the nature's way of balancing life on the planet. Move on, my dear ones !
-----------------------------------------------------------------------
---------------------------------------------------------------------------------------------
The following are the links to my 'scribblings' on some other viruses:
SYMPTOMS, DIAGNOSIS, PREVENTION and TREATMENT SYMPTOMS: The symptoms are like those of most viral fevers - 'cold and flu-like' symptoms - mainly fever, cough, shortness of breath and tiredness. During the third week of April, 2020, the CDC (USA) added another 6 symptoms -- chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell. It is reported that loss of smell and taste may also be present. 'Chest X-rays' may show abnormalities in lungs. Lung infection, mainly, and kidney / heart failure in some may lead to death. Elderly people and those with co-morbidities (diabetes, heart disease, lung disease, kidney disease, etc.) are more vulnerable. And, men seem to be more vulnerable, possibly due to the higher levels of ACE2, one of the strongest biomarkers (European Heart Journal). Symptoms after recovery: According to a study published in the Journal of American Medical Association, 87.4% of the patients complained of symptoms, particularly of weakness and breathlessness, even two months after being discharged from hospitals. DIAGNOSIS:  'Next Generation Sequencing' which scans the entire virus genome, unlike the RT-PCR (70 - 80%), gives more accurate results (97%).  Real time RT-PCR stands for real time reverse transcription–polymerase chain reaction. We are mostly relying on the result of this test to know whether a person is infected with the SARS-CoV-2 virus or not. Those who are tested positive in any country are called "cases" though they may not be patients suffering from symptoms. And, more importantly, this test may give 'false positives' (meaning a positive report of a non-infected person due to some errors) and 'false negatives' (meaning a negative report of an infected person due to some errors or due to the inherent incapacity of the test to detect which itself may be as high as 30% !) These pitfalls are to be taken into account while diagnosing. This is why a clinical diagnosis is as important as the lab tests which may mislead us. There is an excellent article by Dr. T. Jacob John and Dr. M. S. Seshadri (The Hindu, July 1, 2020) on this subject -- go to the link: Many countries are working with the IAEA to use real time RT-PCR to diagnose a variety of human, animal, and zoonotic diseases, including COVID-19. CBC, LFT, CRP, Serum Ferritin, D Dimer, LDH are some of the investigations which would be of help. 'Chest X-rays' may show abnormalities in lungs. Lung infection, mainly, and kidney / heart failure in some may lead to death. Elderly people and those with co-morbidities (diabetes, heart disease, lung disease, kidney disease, etc.) are more vulnerable. And, men seem to be more vulnerable, possibly due to the higher levels of ACE2, one of the strongest biomarkers (European Heart Journal).
As coronavirus affects lungs in most of the cases, Chest X-ray / CT scan would be an important diagnostic tool. Very widely varied abnormalities were noted within a week or two - mostly of pneumonia. CT Chest yielded more information -- Peripheral lesions, Ground glass appearance, Patches of consolidation, Reverse halo sign, Air bronchogram, Vasculation sign, Prominent pulmonary vessels, Crazy pavement pattern. Clinical features, serum markers and CT chest are more dependable than RT-PCR test alone. "RECOVERED" patients tested "POSITIVE" and / or "SYMPTOMATIC" !!! Weeks after making full recovery, 260 people tested positive (RT-PCR) in South Korea. It was confirmed that 'dead virus fragments' were still present in the recovered patients. These were labelled as 'false positives'. In Wuhan Pulmonary Hospital, 651 'recovered' patients were found to be 'positive' in about two weeks after discharge. And 35% of them had one or two symptoms. These patients may be infective, while the others may only be having 'Residual non-pathogenic viral components'. Symptoms after recovery: According to a study published in the Journal of American Medical Association (JAMA), 87.4% of the patients complained of symptoms, particularly of weakness and breathlessness, even two months after being discharged from hospitals. A study published in the JAMA (July 2020) revealed that 80% of the 100 patients who recovered from COVID-19 had 'heart inflammation' and cardiac manifestations (Germany's University Hospital). SERUM MARKERS are important in the diagnosis. PREVENTION: The most important preventive steps would be: 'testing / tracing / isolating as well as ideas to deploy a population health surveillance technologies like smart thermometers (Kinsa) and oximeters." And, there are only general preventive tips: Live a good hygienic lifestyle, Upgrade personal hygiene -- wash hands frequently with soap and water after touching common objects; cover nose and mouth while sneezing or coughing; wear a mask, avoid to stay in close proximity of people suffering from cold, cough, fever or flu-like symptoms; "Social / physical distancing" --keep one metre distance from others; avoid touching face, nose and eyes without washing hands; avoid crowded places; avoid travel with people from countries of high virus burden; thoroughly cook non-vegetarian food; keep surroundings clean and disinfected; reduce direct unprotected contact with wild or farm animals. Avoiding touching nose with infected hands is important as 'Goblet and Celiated' cells in noses have high levels of 'Entry Proteins' that may get attached to the 'Spikes' on the coronavirus. There’s currently no vaccine to prevent coronavirus disease (COVID-19). You can protect yourself and help prevent spreading the virus to others if you: Do Wash your hands regularly for 20 seconds, with soap and water or alcohol-based hand rub Cover your nose and mouth with a disposable tissue or flexed elbow when you cough or sneeze Avoid close contact (1 meter or 3 feet) with people who are unwell Stay home and self-isolate from others in the household if you feel unwell Don't Touch your eyes, nose, or mouth if your hands are not clean The preventive measures mentioned above are of paramount importance: Using soap and water is the cheapest and best, more effective and much less costly than alcohol-based hand rubs or the antiseptic lotions to clear the hands of dirt and grease. Face masks may be beneficial in a general way and when one is near people coughing and sneezing, but not absolutely essential when in clean surroundings. Of course, the scare and the undue importance given to the hand sanitisers, antiseptic lotions and face masks have pushed up their sales and made them disappear into 'black market' !  https://www.newindianexpress.com/todays-paper?sectionname=Opinions&date=05-24-2020 If you read the article cited in the above link, you may doubt the scientific validity of the ICMR's decision on HCQ. A publication in the LANCET indicates that there is no benefit of HCQ in treating COVID-19 patients. It also mentions of more cardiac problems and deaths ( https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext#seccestitle70 ). To know more about Chloroquine and Corona, click on: http://drtramaprasad.blogspot.com/2017/04/coronavirus-covid-19-2019-ncov.html  A large study sponsored by University of Oxford on the efficacy of Chloroquine in preventing COVID-19 is going to take place - May 2020 to May 2022 ( https://clinicaltrials.gov/ct2/show/NCT04303507 ). According to the protocol of this study, a loading dose of 10 mg per kg of body weight of Chloroquine base is to be followed by 150 mg per day for 3 months. Some people in India have already started taking Chloroquine, and if the trend catches up, the stock on the shelves would vanish as happened in the US ! Right now we don't know for certain the protective value of Chloroquine. And, there seems to be some evidence to suggest that some anti-diabetic drugs (Metformin, DPPA inhibitors - Gliptins - Sitagliptin, etc.) may prevent attack by COVID-19.  Many natural food items which we take traditionally improve collectively our immunity generally against all the disease producing elements, including coronavirus. It is said that Indian food items are more immunogenic due to some ingredients -- spices, condiments, garlic, turmeric, pepper, ginger, curd, buttermilk, traditional cereals, pulses, etc. Various studies, 'telescopically' study various food items and draw conclusions that 'this is good for this' and 'that is good for that'. Manufacturers take out some substances from these food items, project these study results, often out of context and commercially exploit the market ! For example, there is a study done at University of Queensland, Australia ( https://thevaultzmag.com/index.php/vaultz-daily-brief/bananas-help-prevent-coronavirus ) which indicates that bananas confer immunity against the coronavirus by virtue of good amounts of vitamins B6, vitamin C, etc. One may extract something out of one banana, put into a capsule and sell it for 100 rupees ... you may as well buy 10 bananas for that amount and enjoy eating them ! And there is the fake news that tea inhibited coronavirus and that tea is being given 3 times a day to patients in China ! About tea, go to http://www.thehindu.com/    Keep "SOCIAL DISTANCE" dear pumpkin lovers ! LOCKDOWN for prevention India is under LOCKDOWN (march-April, 2020) which is considered as the most effective preventive step to stem the rot. The Central Government is in a mission mode and the State Governments have to be as proactive. Ultimately, it is in the peoples hand. It all depends on how meticulously they follow the advisory and the rules. The bitter pill may not be liked, but the result would be sweet. The 'LOCK DOWN' has, in fact, given a chance (at least to those in the higher income groups) to improve their health and lifestyle (over a short period of time) --- timely home food (sans junk food), exercise in sunlight (jogging on terraces), enough sleep, no work tension, less spending and more saving (for the salaried segment). Here again, it is up to the people to use this opportunity this way or to be as in the photo below:  However, there are experts in the field who think sceptically about the benefits of lockdown. It may all depend on the specific situation in a locality or the country at a particular point of time. An editorial in a world famous medical journal, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30938-7/fulltext ). Our own advisors seem to have followed double standards as can be inferred from the following report:   It is LIFE versus MONEY. Without life there's no money, and without money there's no life. It's the affordability of a country that should decide the type of the 'LOCKDOWN'. Different 'pundits' expressed different views. America is an example of the conflict, Trump backing the protestors against lockdown in some States. For India, perhaps, a 'soft and selective lockdown' without a big blow to economy might have been desirable. The police, officials and army, if necessary, could have been posted inside (now, they are posted outside) the working places and educational institutions to enforce preventive measures in addition to 'educate' them on precautions to be taken in daily life. it's all hypothetical and conjectural due to insufficient information about this disease. Anyway, we are half way through now (20.04.2020). Let's see the results. Is LOCKDOWN an economically sound decision ?  It is a fiercely debatable subject. There are various ways of assessment. One is to apply the 'human capital' concept of economics. If there is no lockdown the economic loss due to 5 million deaths would be about Rs. 20 lakh crore. If there is a lockdown the economic loss due to disruption of production would be Rs. 7 lakh crore. Which is higher ? Critics may not agree with this model of calculation and the data factored in. For more details, click on: https://www.newindianexpress.com/opinions/2020/may/07/lockdown-an-economically-sound-decision-2140161.html But, how long can we keep the watermelon without opening ? DON'T GET SCARED ... use the troika of 'masks, physical distancing and hygiene', in a logical and measured way. Cooperation of the public and the participation of the 'private medical sector' are crucially needed. Mid-course corrections are necessary as there are many knowledge gaps in the 'corona compendium'. According to a study conducted in South Africa a lockdown would kill 29 times more people than it saves. The extent of economic damage would be anybody's guess. A little more about this may be found under the subheading "LOCKDOWN SYNDROME" in the above pages.Clear understanding of the facts about this disease and voluntarily applying the knowledge goes a long way to prevent morbidity and mortality, rather than coercive and punitive measures. FACE MASKS  Smile is the most enchanting expression of a human being which has the most positive value. Alas, it made an obscure retreat behind a face mask ! A smile used to add tremendous value to a face. Now it is reduced to zero. The mask turned smiling faces into inanimate objects. We don't know whether a receptionist is inviting us with a smile or sullenness.  Yet, fashion is unique. FASHION is a very powerful facet of a human being, even when the world is in the throes of a pandemic. For example, see the $185 Luxury Face Mask from Belgium in the photo. Interestingly, I stumbled upon an article written by a school student on FASHION which you may read in the link below. -- T. Rama Prasad. https://bluemaskjolting.blogspot.com/2020/08/do-we-need-fashion.html Primarily there are 3 kinds of masks: 1. Cloth masks 2. Surgical masks 3. Respirator masks. For details, Click on: "MASKS CONUNDRUM: The much maligned WHO which hemmed and hawed over the efficacy of masks even when this juggernaut virus begun to leap across continents, has now came out favouring use of masks." -- Dr. T. Rama Prasad, 'Pay What You Can' Clinic, Perundurai. Wearing of a mask by one who is coughing or sneezing offers good protection to the others around. (1) A cough may release 3,000 droplets of secretions. Each droplet may contain up to 2 million virus particles. (2) A sneeze may release 40,000 droplets at a speed of 320 mph ! (3) A single minute of loud speaking could generate 1,000 micro droplets. According to aerodynamic studies, droplets of the size of 18 to 50 microns can travel up to 13 feet in the still ambience. (4) Also read under the subheading "MODE OF TRANSMISSION" on this page further up. A study published in strategy does make sense. "Interestingly, the much maligned WHO, which hemmed and hawed over the efficacy of masks even when this juggernaut virus begun to leap across continents, came out with a protocol" now (June 2020) that favours using masks -- Senior Citizens : Medical Mask; Others : 3-layer fabric Mask.  According to this, if all the 'carriers' wear masks and no one else wears a mask, the risk is only 5%. And if this 5% is to be brought down to 1.5% (not much difference), the whole ocean of 'healthy contacts' has to wear masks to be protected from this drop of 'carrier' ! Here the caveat is 'how big is this drop' ! No one knows -- that's the problem of the WHO which had been reluctant to declare mask as essential until June 6, 2020. And, it should be remembered that the 'transmission probability' figures were mostly obtained from 'simulation' and 'mathematical models', not from field conditions.
History: Jan 29, 2020 -- WHO said "In community settings, face mask is not required by individuals without respiratory symptoms Feb 5, 2020 -- CDC does not currently recommend face masks as a preventive as there is no community spread in the US. Feb 29, 2020 -- The US Surgeon-General said "stop buying masks ... not effective for general public." April 6, 2020 -- WHO continued to discourage people from wearing a face mask. June 5, 2020 -- WHO reversed its position saying masks protect individuals from coronavirus infection. June 11, 2020 -- A paper was published in the Proceedings of the National Academy of Sciences documenting the benefits of wearing face masks. But 85 scientists raised a hue and cry about serious errors in the methodology and wrong data projections of the study and demanded retraction of the paper ! An egregious blunder. And now (July 2020) another debate is going on -- whether it is an 'airborne' infection or not. In an 'open letter' to the WHO, 239 scientists from 32 countries have asserted that this virus can infect through small aerosol particles of less than 5 microns in size which can be 'airborne'. They want the WHO to revise its recommendations on prevention based on this evidence. These small droplets can spread much beyond 3 feet and infect. "DON'T USE VALVED N95 MASKS"  And now on July 20, 2020, the Union Health Ministry advised public not to use 'Valved respirator N95' face masks. The one-way valve is incorporated in N95 masks to (1) prevent moisture / sweat build up and heat build up (10degrees F lower) inside the mask area, and to prevent fogging of glasses (2) make breathing (exhalation) easier. The downside of the valved mask is that it allows aerosols (which may contain microbes) in the breathed out air to go out without filtering. Anyway, how many millions of the 1.3 billion are using the costly 'Valved N95 masks' ? This is a very fussy subject. If one wants to be more fussy, one must buy a "Fit Test Kit" to determine which size, style and shape of a mask fits the face. Just go out on to Indian roads and see our 'mask culture' ! We talk about the importance of micronutrients in our diet while we have the 'silent killer' of chronic malnutrition, which is a euphemism for slow starvation ! And, Chinese stopped wearing masks in general public areas with normal people around, perhaps because they may not be much benefit. And finally, the efficacy of a mask depends on the quality of the mask and the properness of wearing the mask. As we see in India, most of the people don't wear the mask properly -- it is just piece of cloth loosely hanging over the nose, mouth or neck. Some visible piece on the face to escape punishment just as they put something like a hemet on handlebar or on head when helmet-wearing is made compulsory for two-wheeler riders ! If everyone wears a right mask in a proper way, there wouldn't be a need for 'lockdown'. That's THE LONG AND THE SHORT OF the masks !!! And then, FUNNY MASKS !        
 NEXT ADVISORY: Never get married, but may have 'Test-tube' babies !!! -- Dr. T. Rama Prasad, PAY WHAT YOU CAN Clinic, Perundurai. http://drtramaprasad.blogspot.com/2017/04/lockdown-medicine.html  CORONA TSUNAMI devastated lifestyle and economy on this planet. The world would start limping back to normalcy only when people would no more need to wear face masks. WHEN ? ... may be 6 months, 6 years or never !!! - Dr. T. Rama Prasad, PAY WHAT YOU CAN Clinic, Perundurai. THAT's ABOUT MASKS -- in 'lighter & serious vein' !!!  AMERICA -- "The Land Of The Free". Should we wear the face mask or not ? The LAND of the FREE: While the medical head of that land said no, the administrative head ventilated about the freedom. They are at loggerheads. 'Uncle Sam' assured that the citizens will have the freedom to choose between 'mask' or 'no mask', in 'the land of the free'. Wisdom and science of the POTUS !!! VACCINES and TREATMENT  Lure of speed of entry and making a fast buck often put quality concerns on the margin. A lot of fraud is being committed in research and treatment. If inquisitive to read about it, click on the two links below: http://drtramaprasad.blogspot.com/2017/04/coronavirus-covid-19-2019-ncov.html http://drtramaprasad.blogspot.com/2017/06/modern-medicine-good-bad-ugly.html HYDROXYCHLOROQUINE: A shame on researchers and a blot on medical journals. An apology was tendered and the article in The Lancet was retracted.
Researchers all around the world are working at a furious pace to make a vaccine 'immediately' ! Over 70 groups are working with100 vaccine candidates and 460 clinical trials. They want to make it in 2020 itself. But it could be 2030 or never ! There has been mounting criticism from the world medical community that regulatory authorities are bowing to political pressures. It is a global competition -- academic and commercial as well, and even political ! And, a vaccine nationalism ! For instance, the mindlessly hurried Russian vaccine Sputnik V is like a Russian roulette. If it succeeds, it's a bounty, otherwise it's a disaster to the humanity. Who can regulate ? There is also the urge as the global economy is on the verge of collapse. The race is against time. The race for a vaccine is more of a marathon than a sprint. That's the reality. (1) On July 22, 2020, the Trump administration inked a 2 billion dollars deal for 600 million doses of COVID vaccine with Pfizer and BioNTech, even before the development of the vaccine. The US biotech firm Moderna's vaccine candidate has shown some promise and will enter final stage trials in July 2020. (1a) mRNA COVID-19 vaccine. (2) British (Oxford) ChAdOx1 nCoV-19 (AZD1222) vaccine uses 'live chimpanzee adenovirus type 5' - initially failed in monkeys, but being tried in volunteers. Being on a 'tried-and-tested' platform 80% success is predicted -- may be available by the end of 2020 for Rs.1,000, made from the Serum Institute of India, Pune. (3) 'Challenge' trials of COVID-19 vaccine -- involving infecting willing people with the virus to know the protective effect. (4) "COVAXIN" is an indigenously developed 'inactivated vaccine' at the Hyderabad-based (India) vaccine manufacturer, Bharat Biotech. It's permitted to do Phase I & II human clinical trials in June 2020 --results expected in October 2020. Meanwhile the ICMR chief kicked up a 'scientific storm' by 'ordering' completion of the trials 'quickly' so that the vaccine could be ready for use by August 15, 2020 ! (5) "ZyCov-D" is the vaccine candidate of Zydus Cadila, slated to complete late-stage trials by March 2020. (6) Russia and China may suddenly market their vaccines any time. Chinese firm CanSino Biologics Inc is developing a vaccine (Ad5-nCoV) based on the adenovirus mechanism. It is approved for use by Chinese military and is lined up for being tested in Russia, Mexico and Saudi Arabia, having obtained a patent approval from Beijing. On 11.08.2020, President Vladimir Putin said that Russia had become the first country to grant regulatory approval to a COVID-19 vaccine to be called 'Sputnik V. This has raised concerns as this has not passed through the customary tests for efficacy and safety. This vaccine consists of two serotypes of a human adenovirus, each carrying an S-antigen of the new coronavirus, which enter human cells and produce an immune response -- a recombinant adenovirus type 26 (rAD26) vector and a recombinant adenovirus type 5 (rAD5) vector, both carrying the gene for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein (rAD26-S and rAD5-S). So far, adenovirus vector vaccines have never been used as commercial human vaccines except for a rabies vaccine and in some experimental studies.(7) Monoclonal antibodies. (6) Numerous drugs and treatment protocols. These are all in the pipeline -- may come out or not ! https://indianexpress.com/article/india/covid-19-vaccine-may-be-ready-in-12-18-months-says-who-chief-scientist-6478396/  Celebrate INDEPENDENCE DAY with our corona vaccine. Even the baby is laughing at the idea ! Fast-tracking medical research studies is a matter of concern. Can we produce a baby in one month bygetting nine women pregnant !!!" Russia named its yet to be born baby "Sputnik V". Let's rename ours as "Chandrayaan C" ! -- T. Rama Prasad.  This is going to be a long haul ... don't expect magic bullets or silver bullets. However, amidst the doom and gloom, there is the news today (19.05.2020) (1) that volunteers who received the US vaccine (mRNA-1273 of Moderna biotechnology company) showed good immune response, and (2) that at China's prestigious Peking University, a new way of treating with 'Neutralising Antibodies' made from the blood of recovered patients using 'Single-cell Genomics' technology is being developed.  The jury is still out on treatment protocols. Corona would have been unknown to the common man if it didn't kill so fast, so many and in so many countries. If many didn't die, it would have been just another 'flu' and just another permanent guest ! Now, common people know of some 'desivir' or some 'zumab' ! A great majority of the cases recovered without intensive treatment. A few patients (around 3 per cent) succumbed in spite of intensive care -- and a few of these few might have died due to the "intensive care" with needless ventilators and heroic treatment without tackling inflammation and thrombosis ! We have to restructure our strategies based on recent postmortem findings which point to an unthought of pathophysiology. The sudden and conventionally unexplainable deaths might have been due to a massive 'tsunami-like' 'allergic reaction' -- a 'cytokine storm' of widespread severe inflammation resulting in disastrous occlusion of small blood vessels due to micro thromboembolism / disseminated intravascular coagulation / vasculitis in lungs and other vital organs as well. Some observations of endothelitis and vascular complications suggest that the disease is systemic and mainly involves the vascular endothelium. Still, these insights into the pathology of severe COVID-19 are only hypothetical. Ventilators and oxygen couldn't save, as the problem was elsewhere. Hypoxia didn't respond to PEEP. Anti-inflammatory drugs, thrombolytic agents and blood transfusions were not given priority in the first three months of the crisis. Viral myocarditis with elevated troponin was not actively studied. COVID-19 is more than a lung infection. It affects the blood vessels of lung and many other organs. It produces blood clots (thrombosis) associated with acute life-threatening events. Some recommend a low dose of HEPARIN and Aspirin to all COVID-19 patients admitted into hospitals to prevent clot formation. And some suggested TISSUE PLASMINOGEN ACTIVATOR which helps dissolve clots. A specialised test, Thromboelastography (TEG) is being studied. This test is a whole blood assay that gives a lot of information about blood clots. It is not yet clear as to what extent these clots are responsible for the deaths. https://www.medicalnewstoday.com/articles/are-blood-clots-to-blame-for-covid-19-deaths Our biological protective reaction to corona is a double-edged weapon - it may kill the virus or it may kill us also through overreaction ... Cytokines & Interleukin-6 (IL-6) ramp up immune response ... Macrophages, CD4 T, CD8 T initiate immune response and protect us. All these are our 'biological policemen'. But too much of a response may harm us -- too much of macrophage inflammation may damage normal lung cells and kill us also. When policemen harm people, we have to correct them, not abandon them -- same is the case with our 'biological policemen'. How to suppress this overreaction of our immune system ? There are some drugs, but they may compromise our defence system by over suppressing ... IL-6 inhibitor, Actemra (Tocilizumab) and IL-1 modifier, Anakinra reduce the flow of macrophages into lungs without hampering CD4 & CD8 cells -- so they are less compromising, but very costly and not easily available. Next alternative -- steroids like prednisolone .. very cheap and available everywhere, but they suppress the immune system very broadly, very compromisingly. When nothing else is there to save a life, steroids are being tried in some countries during 'cytokine storms'. Who knows ? Though the WHO is against steroids, they may be life-saving ! In fact, some promising evidence has come-forth to proclaim that DEXAMETHASONE is a life-saving drug. It is a very cheap (few rupees)and very widely available drug. The anti-inflammatory drug TOCILIZUMAB seems to be a promising life-saving medicine -- about 50,000 rupees per dose. Itolizumab, an injectable monoclonal antibody drug in use for the skin disease 'Psoriasis', reduces inflammation by inhibiting key inflammatory markers like IL-6 and TNF and hence may be useful in tackling 'cytokine storm' of COVID-19, according to some evidence. The Central Drug Standards Control Organisation (CDSCO) said that after detailed deliberation the Drug Controller General of India (DCGI) decided to grant permission (July 2020) to market the drug for the treatment of Cytokine Release Syndrome in moderate to severe Acute Respiratory Distress Syndrome (ARDS) of COVID-19 patients. But some experts are not impressed by the data, presented by the company to the DCGI of the study of just 30 patients across 4 hospitals of whom only 20 were given Itolizumab along with 'Standard Care Treatment', to justify such a permission. They also pointed out that conducting Phase 3 trial was waived which is a bad move scientifically. It costs about Rs. 7,500 per pack (Alzumab of Biocon). PRONING CANCER DRUG: Ex-vivo studies indicate elevated Bruton Tyrosine Kinase (BTK) activity, as evidenced by autophosphorilation and increased IL-6 production in blood monocytes, in severe COVID-19 patients. This has lead to the study of ACALABRUTINIB which targets activated BTK in macrophages and reduces inflammation. Acalabrutinib (Calquence of AstraZeneca) is already in use in cancers like Chronic Lymphocytic Lymphoma / Mantle Cell Lymphoma. Administration of Acalabrutinib (off-label drug for COVID-19), a BTK inhibitor, showed clinical improvement as published in the journal 'Science Immunology' on June 5, 2020 --https://immunology.sciencemag.org/content/5/48/eabd0110 Like methemoglobin, the 'virus structural protein' may stick to heme, displace oxygen, displace iron, and the free iron toxicity (high Fio2) may cause inflammation of alveolar macrophages. Radiological images may be vaguely interpreted as 'pneumonia', 'infiltration', 'consolidation', 'ground glass lesions' or some fancy term. Frequent transfusions of RBC / blood may be beneficial. PLASMA THERAPY  CHOLCICINE Scientist in Israel discovered a chemical known as Alpha Defensin produced by WBC can cause the micro-clots in blood vessels of lungs, and that this can possibly be prevented by a drug called CHOLCICINE, a drug used for many decades for treating Gout. METFORMIN Metformin, widely used for diabetes, may prevent the entry of this virus by interacting with ACE2 receptors to which the virus binds and gains entry into the body. This drug may reduce elevated blood glucose levels, and this virus itself may produce Type1 diabetes by destroying beta cells in the pancreas that produce insulin. It is advisable not to use this drug in combination with HCQ. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190487/ HYDROXYCHLOROQUINE (HCQ) IVERMECTIN Ivermectin, an approved drug for treating various parasite infestations, is under study for its anti-viral action as it was found to inhibit the replication of COVID-19 with an IC50 of2.2 - 2.8 uM. It is a potential anti-virus agent in Chikungunya and Yellow Fever. Ivermectin has grabbed headlines for wrong reasons. Based on the study data of Surgisphere, the company behind some discredited research studies (including those of HCQ), officials of Latin American countries recommended ivermectin as a possible coronavirus drug. Clinicians there say the effects have been extremely devastating. People emptied the drug stores and self-medicated with no scientific indications, and entered into a false sense of safety. Back in India the UP government officials approved (August 2020) ivermectin for treatment and prevention of COVID-19, based on the evidence of a handful of in vitro and observational studies. One Prof. Thomas Borody from Centre for Digestive Diseases in Australia 'believes' that ivermectin with zinc and doxycycline is a cure for COVID-19. Prof. Ian Musgrave, a molecular pharmacologist from the University of Adelaide said: "Prof. Borody's 'belief' is to be taken with a pinch of salt as ivermectin acts only in test tubes." Prof. Borody wondered why Australia didn't consider his recommendation to include ivermectin in COVID-19 treatment while the 'HUGE INDIA' approved it ! Uttar Pradesh government approved it in August 2020. Concerns have been raised that human use of ivermectin may do more harm than good. The hype has shifted from HCQ to Ivermectin. It's no wonder Miss Corona made people lose faith in "scientific" medicine ! The Pan American Health Organization, a regional office of the World Health Organization, has issued a statement warning against the use of ivermectin to treat COVID-19. The statement notes that the antiparasitic drug is being investigated in clinical trials, but currently, “ivermectin is incorrectly being used for the treatment of COVID-19, without any scientific evidence of its efficacy and safety for the treatment of this disease.” For details go to the links below: Combinations of drugs with Albendazole / Doxycycline are also being tried. All the above mentioned remedies are to mitigate the impact of the virus but not directly to neutralise the virus. AYUSH -- systems of alternative medicine - indigenous Various preparations belonging to the alternative systems of medicine in India, some approved and some not approved by governments are in the market as claimed to prevent / cure COVID-19. 'Arsenicum album 30' is one which is said to be recommended by the State governments in Rajasthan, Karnataka, Tamil Nadu, Andhra Pradesh and Kerala. 'Coronil' of Patanjali is another brand in the market after settling a dispute about the claims. Zingivir-H is an Ayurveda (system of 'Alternative Medicine') drug which is approved for trials in Indian patients. "Another patient of about 40 years with high fever and who tested positive for COVID-19 in USA tested negative for Covid-19 with Ayurvedic medication. A detailed case study has been cited ( If the treatments promoted to treat COVID-19 by the alternative systems of medicine are not to be "derided or scoffed at", the ICMR should guide them to conduct RCT studies of robust and hard caliber to prove their worth. At present (June 2020), there is no conclusively proven specific drug or vaccination against the virus. But lives may be saved by giving supportive and symptomatic treatment.  PLATELET THEORY: It is opined that platelets are the ones that lead to lung inflammation. CD13 (Human receptor) and HCoV-229E strains are 82% similar to SARS-CoV-2 which share similar function to intake the virus (University of Perugia, Italy). As it stands today (June 2020), most of these drugs are being used as "Compassionate / Emergency / Salvage" drugs, meaning that the drugs are permitted to be used for study or as a last resort, with some evidence in their favour but not yet conclusively proven to be effective and safe in COVID-19 disease. Remdesivir Favipiravir - brand name: Fabi flu - a course of 15 days costs around Rs. 13,000 per patient - Tablets 200mg - 1800mg twice a day for one day followed by 800mg twice a day for the next 14 days. These two antiviral drugs may be available in India from July 2020 for 'regulated' use in COVID-19 cases. Transfusions of RBC / blood, anti-inflammatory steroids, thrombolytic drugs, 'plasma therapy', antibiotics, immunotherapy, etc. are also being employed. And, some centres are trying the anti-malarial drug Chloroquine to prevent / cure this disease without conclusive evidence of its efficacy. A publication in the LANCET (22.05.2020) of a large multinational real-world registry analysis indicates that there is no benefit of HCQ in treating COVID-19 patients. It also mentions of more cardiac problems and deaths ( https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext#seccestitle70 ).Consequent to this publication, WHO suspended its HCQ drug trial, over safety concerns. France, Italy and Belgium have stopped using HCQ from 27.05.2020. Touting of this drug by Trump and his outbursts at WHO about -China issue is a different story.  American Association of Physicians and Surgeons (AAPS) is supporting Trump on his HCQ statement. (https://www.theguardian.com/us-news/2020/may/24/hydroxychloroquine-trump-us-doctors-coronavirus) Some are using 'Blood Plasma' donated by patients who have recovered from COVID-19 as a treatment option. Interferon alfa 2a and 2b is also under trial. Some are using cells grown from human placenta -- Placental Expanded Cells.Corona lung infection seems to exhibit very uncommon features. Patches of pneumonitis were seen in 'chest X-rays' even when the patients had minimal symptoms - as in the first case in the USA ( Link to the first case report: https://www.nejm.org/doi/full/10.1056/NEJMoa2001191
In some cases, the lesions rapidly progressed within hours / days and killed. Oxygen availability in tissues was unexpectedly low though the blood oxygen didn't fall as much. Hypoxia (low amount of oxygen reaching the body tissues) - even 75% - was out of proportion to the breathlessness or 'X-ray' changes. As such, conventional oxygen therapy or ventilator support didn't yield the expected results. Around the 10th day, patients died of 'cytokine storm', acute ARDS, multi organ failure, etc. The speed and the volume of loss of life over a short period of time is the main concern. The spread and the pathogenesis of this virus would be an everlasting enigma. https://www.drugs.com/medical-answers/ivermectin-treat-covid-19-coronavirus-3535912/prevent development of COVID-19 in certain high-risk groups, just as is the case with Hydroxychloroquine ? We don't know yet. Combinations of drugs with Albendazole / Doxycycline are also being tried.  The US president Trump had declared that Chloroquine was approved in the US to treat COVID-19. But Fauci, the top US expert in infectious diseases, contradicted it saying that the drug needs to be studied for its efficacy against the coronavirus and that the claims are only 'anecdotal' ! The following is a report in the press: ... "A run on anti-malaria drugs chloroquine and ...19 hours ago: Hospitals and doctors are wiping out supplies of Chloroquine, an unproven coronavirus treatment. Lack of definitive evidence has not stopped exploding ... " One Chinese publication indicated that Chloroquine may be beneficial in treating Coronavirus Pneumonia ( https://www.ncbi.nlm.nih.gov/pubmed/32164085 ). To know more about Chloroquine and Corona, click on: http://drtramaprasad.blogspot.com/2017/04/coronavirus-covid-19-2019-ncov.html https://drtramaprasad.blogspot.com/2017/04/coronavirus-covid-19-2019-ncov.html And, there are reports that Hydroxychloroquinde killed some in the US !!! Clin Med COVID article May 2020.2020-0188.full.pdf  At the end, what's the correct protocol of treatment ? GOK ! But, Miss Corona, we shall continue to fight. We have lots of weapons. Chloroquine to Favipiravir ... Actemra to Anakinra ... Interferon to Immunoglobulins ... miRNA to has-mir-27b ... Gangajalam to gomoothra and so on. ----------------------------------------------------------------------- WHO and POTUS "Both utter and do amusing and improper things. In the context of the Covid Pandemic, both are accused of functional inefficiency, organisational lethargy, paucity of decisive leadership, bureaucratic indolence and shifting strategies. WHO made another U-turn on 17.06.20 and dropped Hydroxychloroquine (HCQ) from SOLIDARITY (CORONA) drug trial. Trump seems to have made WHO lost its mental balance. Click on the link below to read about the sensational story about HCQ, Trump, WHO, The Lancet, NEJM, medical frauds and tricks, and the politico-pharmaceutical ramifications based on influence and money." -- T. Rama Prasad https://drtramaprasad.blogspot.com/2017/04/coronavirus-covid-19-2019-ncov.html WHO -- (1) Initially, denied person-to-person transmission of coronavirus. (2) Denied and delayed declaring COVID-19 as a pandemic by 2 weeks. (3) Initially, it announced that mask-wearing was not necessary for the uninfected. But after a few months recommended face masks. (4) Said that recovered patients are unprotected by antibodies from re-infection. (5) Alleged influence and haste in declaring H1N1 as a pandemic. (6) Hastily suspended its HCQ drug trial and made a U-turn next week. Again made a U-turn to stop HCQ arm of the trial.    TRUMP thought that the LION was in CHINA -- mislead by the guide called WHO ! After realising the fact, he stopped funding the WHO. https://www.newindianexpress.com/magazine/2020/may/03/coronavirus-chronicles-descent-into-horror-2137496.html(https://www.newindianexpress.com/opinions/editorials/2020/apr/27/trumps-attempt-to-disinfect-patchy-corona-record-2135734.html ) CORONA and KAWASAKI  ( https://www.livescience.com/covid-19-and-kawasaki-disease-children.html ) ( https://www.bbc.com/news/health-52648557 ) Similar cases were found in New York, London and France. The chief of WHO, Tedros Adhanom Ghebreyesus said in May 2020: "It is critical to urgently and carefully characterise this clinical syndrome, to understand causality and to describe treatment interventions." SMOKERS and CORONA   There is an unexpectedly good news for smokers ! A top French neurobiologist said nicotine in tobacco gets attached to ACE2 receptors to block entry of CORONA virus ! It may also lessen the 'cytokine storm' of COVID-19 ! In Paris hospitals, only 8.5% of the 11,000 Covid-19 patients were smokers while 25% of the population in France are smokers ! Please don't cite this as an excuse for smoking !!! -- Dr. T. Rama Prasad, EYE and CORONA  The digital wizardry of modern technology has burdened the EYE very much. During the LOCK DOWN period, the organ most overused is the EYE ... electronic screens, newspapers, books. And now, another new risk is added to the eyes of students -- online E-classes. Authorities should realise that continuous viewing on electronic screens may be detrimental to the eyes of the pupils. A break of 5 minutes may be given after every 20 minutes of teaching. And for everybody the rule of 20-20-20 is recommended -- after every 20 minutes of exposure to digital screens see objects beyond 20 feet for 20 seconds before resuming the activity. After the 'corona period', have your eyes checked up if you hadn't recently. I am not an eye specialist ! During the 'corona period', (1) Don't touch your eyes. If necessary, wash your hands thoroughly before you touch. Coronavirus may gain entry into the body through eyes and may spread through eye secretions. (2) Wearing glasses may add a layer of protection. If wearing contact lenses, switch over to ordinary glasses during this period. 1 to 3% of corona patients may get "pink eye" (conjunctivitis) which may be a rear early symptom of coronavirus. It may be interesting to know that the Chinese whistleblower ophthalmologist, Dr.Li Wenliang developed symptoms of coronavirus after having treated a woman (for glaucoma eye disease) who was a contact of her daughter who had coronavirus infection. It's unfortunate that this 32-year-old doctor died of coronavirus on February 7, 2020 at Wuhan Central Hospital. Beware of the importance of EYE in relation to CORONA ! SKIN and CORONA  Some skin lesions may give a clue to the underlying COVID-19. People should be wary of it. | ||||||||||||||
PREGNANCY and CORONA  As on July 16, 2020, in Tamil Nadu, 1,606 pregnant women tested 'positive' for coronavirus. At theInstitute of Obstetrics and Gynaecology(IOG) and Hospital for Women and Children, Egmore, Chennai, 39 newborns tested 'positive', accounting for nearly about 12%. National Health Mission has issued 'Special Protocol' for the care of antenatal women to the Comprehensive Emergency Obstetric and Newborn Care (CEmONC) centres and private obstetricians. A four-day-old baby girl tested positive died of Meconium Aspiration Syndrome at Government Rajaji Hospital on August 2, 2020. Her mother also tested positive. Another nine new borns were treated at the same hospital. All this may just be the tip of the iceberg. As of 12th August, 2020, 100 Covid positive women gave birth to their babies at MGMGH, Trichy -- 22 of them were normal deliveries, while 78 were of C-sections. Two of these babies tested positive. It was reported that more cases are being attended to at government hospitals as private hospitals are turning away patients fearing the virus infection. VERTICAL TRANS-PLACENTAL transmission. At least six published studies suggest this route of transmission. A publication in Nature Communications (Daniele De Luca of Paris Saclay University, France, July 2020) has confirmatory evidence that the virus can infect a foetus through mother's blood via placenta. Amniotic fluid positive. Placental tissue positive. Congenital SARS-CoV-2 infection. Cerebral vasculitis - white matter injury - The newborn had neurological manifestations. https://www.nature.com/articles/s41467-020-17436-6Sasson Hospital in Pune, India and some hospitals in the US and France also reported similar cases of vertical transmission. Vertical transmission is well-documented in HIV and ZIKA virus infections. A survey done abroad revealed that many couples now are either deciding to have pregnancy some time later or never to have children, due to the consequences of the pandemic. https://qz.com/india/326402/cesarean-births-in-india-are-skyrocketing-and-there-is-reason-to-be-very-worried/ http://drtramaprasad.blogspot.com/2017/04/modern-medicine-good-bad-and-ugly_30.html COST and CORONA  "COSTLY CORONA: Rs. 600 lakh ($1 million) hospital bill. Yes, it's a costly disease. They didn't overcharge. In India it's much cheaper in private hospitals, and "free" in public hospitals. The choice is there. Spending by the hospitals varies from case to case. Fixing "MRP" may only dilute the standards. Of course, there are black sheep in all the fields." -- T. Rama Prasad    https://timesofindia.indiatimes.com/blogs/jugglebandhi/hospital-hostages-thanks-to-coronavirus-one-sector-of-the-economy-is-making-mega-bucks-like-never-before/ From one point of view, this looks like exploitation and profiteering. Seen from another angle, it looks like a struggle of the private hospitals for existence.https://www.thehindu.com/opinion/op-ed/needed-a-transfusion-for-public-health-care/article31798593.eceand read under the sub-heading "POST-MORTEM of the LOCKDOWN" above. Business crashed. No passengers. No patients. One may hopefully think that these are isolated and aberrant cases occasionally occurring. But if one goes through the following news it seems that it is so rampant that the issue is taken up by a court. TEA and CORONA STORM in a CORONA TEACUP ... 2020  While tea industry is grinding to a halt because of lockdowns around the world, tea is making grand rounds on the Internet. Social media flashed fake news about the benefits of tea in COVID-19. One hurriedly published article (which was later removed) in the WeChat account of Zhejiang CDC on Feb 26, 2020 claimed that drinking tea may help prevent COVID-19, based on the flimsy evidence that tea inhibited proliferation of the virus in vitro (test tubes). Added to this, is the circulating news that the whistleblower Chinese ophthalmologist, Dr. Li Wenliang (who died of coronavirus) had documented evidence to support that tea has anti-coronavirus properties, and that tea was being given 3 times a day to patients in hospitals in China. This is a big fat fake news. Tea has a lot of exciting background. To know more about TEA, read my article published in THE HINDU. The link to the article is given below: http://www.thehindu.com/ GUT and CORONA Prevent transmission through stools.  | ||||||||||||||
THE DEADLY VIRUS.
kissed INDIA on 30.1.2020
kissed INDIA on 30.1.2020
The first case was reported in Kerala in India on 30.01.2020 and the number had rose to 564 by 25.03.2020. The first of the 1 deaths in India occurred on 10.03.2020 in Karnataka. Initially, almost all the cases were in China.
Most airlines suspended many flights to China and other high-burdened countries
– see the video https://youtu.be/-bJHvK4Zb5o Unprecedented – 41 million people in13 cities locked down in China – restricted transport, New Year festivities scrapped. Hospital beds full .. To know more about this and some other viruses, read my ‘Scribblings’ at:
http://drtramaprasad.blogspot.com/2017/05/zika-virus.html , http://drtramaprasad.blogspot.com/2017/10/dengue-virus.html , http://drtramaprasad.blogspot.com/2018/11/swine-flu-h1-n1-influenza.html
Dr. Li Wenliang who posted early warnings of the presence of this virus on his social media group (considered to be an offence and punishable by the local authorities) died due to infection by the same virus ! Dr. Liu Zhiming, the Director of Wuhan Wuchang Hospital and an expert in Neurosurgery, died on February 11, 2020 due to this virus. More than 1,700 medical workers were infected, and six of them died as on 20.02.2020. Most medical staff in Wuhan are said to be infected by this virus. In Italy, more than 100 doctors died of this disease. More than this number of doctors (more than 200) died in India too.
Infected doctors seem to have a 10-12% risk of mortality. This is due to exposure to a HIGHER VIRUS LOAD, which leads to a 'cytokine storm'. People, in general, are usually infected through air and contacts or fomites (infected surfaces). Fomites have a lower virus load, and hence a lower mortality rate of about 2-3%. Doctors attending on the COVID-19 patients, pulmonologists, intensive care specialists anaesthetists and also the staff attending on these patients are at higher risk. The nurses (20%) and sanitation staff (30%) seem to have a higher risk of mortality.
Dr. J. N. Pande, aged 79, joined the premier institute, AIIMS, Delhi as an MBBS student and retired as HOD of Medicine of the same institution. An eminent Pulmonologist, he was an embodiment of knowledge and humility. He passed away in sleep on May 23, 2020. He and his wife tested positive for COVID-19 a few days before the demise, and he had some co-morbid problems. RIP.
It is recorded that about 100 doctors died due to COVID-19 in India in the first half of 2020. The actual figure may be much higher.
 |
| This picture is made of numerous photos of numerous doctors and nurses who died of COVID-19. Magnify the picture and see the small photos. July 1, 2020 -- DOCTORS DAY. We doctors thank you all for the greetings. We want to keep the "PATIENT FIRST" in our minds. This is AC era (After Corona). Patients are afraid of going to doctors. Doctors are afraid of attending to patients. 'Fear Pandemic' is worse than the 'Virus Pandemic'. |
 |
| Diamond Princess Cruise Ship with 3,600 passengers was quarantined in Japan. 356 of them were found to be p[ositive for this virus Some cases across Europe were traced to a business meeting in Singapore attended by more than 90 foreigners in January 2020. International fear has been growing with increased virus cases and deaths in countries outside China -- Middle East, South Korea, Italy, Iran, etc. |
WHAT IS THIS VIRUS ABOUT ?
We don't know much about this new Coronavirus which was informally known as 'CHINA / WUHAN coronavirus'. Later, it was christened as SARS-CoV-2. The World Health Organization (WHO) coined the interim term '2019-nCoV acute respiratory disease' to describe the disease caused by this virus. Later, it was named as COVID-19. This is the new highly contagious virus that is the cause of the ongoing and fast spreading 2019 - 2020 outbreak affecting badly some countries like USA, Spain, Italy and Britain. As many early cases were linked to a large seafood and animal market, the virus is thought to have a zoonotic (animal) origin. But, later experience indicates that it can spread from human to human by close contact such as exposure to coughing or sneezing within 6 feet. Worryingly, one study indicated that the virus can thrive up to 3 hours in the air as an aerosol. And viruses mutate unpredictably. Viral genomes are very diverse -- they can be DNA or RNA, single or double-stranded, linear or circular, may vary in length, number of DNA or RNA molecules may also vary. COVID-19 is a single-stranded RNA type. There are 5 types of clades circulating globally -- Type O, B, B1, A1a, A2a. The Type O strain is the ancestral type (Wuhan strain) -- B type in England, B1 in the US and Singapore, A1a in Italy, A2a in India, mostly. The ancestral type seems to be evolving into A2a in many countries. Sequence diversity is a dynamic process. We can only guess.
MUTATIONS
The coronavirus keeps changing through mutations. The SARS-CoV-2 that is present in India may not be the same as the one that caused the first case in China. There are at least six identified strains of the virus in circulation across the globe. They go on mutating. Some are not effective and die out. Some may become more virulent. While the G strain is the most common (which dominated the earlier D strain after March 2020), some have vanished. As in August 2020, a swap between amino acids, identified as D and G, at position 614 in the code of the virus's spike protein produced a variant mutant called D614G which is currently the dominant strain worldwide. The strains present in the IUS are similar to those in Europe, perhaps due to the travel factor. In Indioa, the first coronavirus was the L strain originating in Wuhan, which eventually mutated into the S and G strains and spread all over the country. Due to closing of borders between States during the lockdown period, different types of mutations might have occured in different States. The Malaysian case from Tamil Nadu raises the possibility of the D614G strain being in Tamil Nadu. A particular vaccine developed may or may not be very effective against a different mutant. Some say that not giving a vaccine is better than giving a partially effective vaccine.
As it is in August 2020, the D614G mutant strain is the predominant variant in some countries in Europe and the US, and is thought to be 10 times more infective than the original Wuhan-1 (SARS-CoV-2) strain. The D614G mutation alters the spike protein, but not the critical 'receptor binding domain (RBD)' immunogenic part at the tip of the spike which binds to the ACE2 receptors on human cells. This is some consolation. There is a report that a Malaysia hotel owner returned to Malaysia from Sivaganga in Tamil Nadu, India on July 13, 2020 and infected 45 people in Malaysia out of which 3 had the D614G strain. He breached his 14-day home quarantine, and was sentenced to five months in prison and a fine. Though this strain may be more infectious, it may not have an impact on the ongoing vaccine development. Mutations are quite common, but cross-protection for mutants also is possible with 'old' vaccines. The information is patchy and needs to be updated. People have to be more cautious in view of the spread of this mutant. We don't know for sure the implications.
HARMLESS MUTANTS are welcome, not D614G strains. Doctor is afraid of seeing a patient. Patient is afraid of being tested. Everybody is afraid of quarantine, social stigma and sudden death. Employee is scared of going for work. Employer is worried about closure of his establishment if an employee tests positive. We are afraid of each other. For how long more ? -- August 2020
We don't know how the virus came to France, but a study published in the International Journal of Microbial Agents indicates that an old sample of one patient (Mr. Amirouche Hammar) treated in December 2019 was positive for the coronavirus. He lived in France with no recent travel history.
" ... CORONA FLOWERS: Physically, coronavirus, looks like a ball of sun with a circle of corona of spikes -- thus derives its name. We identified 3 kinds of flowers which are 'lookalikes' of coronavirus -- (1) Haemanthus / Scadoxus multiflorus (2) Sphaeranthus indicus (3) Memecylon edule !!! -- Mrs. V.S. Rajyalakshmi, M Sc (Botany) & Dr. T. Rama Prasad. ..."
DATURA fruit looks like corona virus.
PETS and CORONA
After the initial event of the 'Wuhan meat and animal market' origin, there was no evidence of spread from animals to man. In late March 2020, a pet cat was found to be infected with this virus in Belgium. In Hong Kong, two dogs tested positive. In April 2020, a four-year-old Malayan tiger in the New York-based Bronx Zoo has tested positive for COVID-19. These four animals seem to have acquired the virus from humans. In Netherlands, one dog and three cats were found to be Corona positive. Two dogs were found to be positive in the US.
Pet parents who tested positive are a lot worried about their dog pets, especially when the parents are quarantined. Who will look after their pets ? In Chennai, some facilities like 'Dog House', Petters' and 'Hotel for Dogs' are providing care for the furry pals of pet parents. Life has been thrown out of whack by the coronavirus. https://timesofindia.indiatimes.com/life-style/spotlight/how-pet-boarding-facilities-are-helping-dog-parents-in-the-time-of-covid-19/articleshow/76862218.cms
At this time, there is no evidence that any animals, pets or livestock, play a significant role in spreading COVID-19 infection to people.
WHY and HOW THE NEW VIRUSES
EMERGE ?
EMERGE ?
We don't exactly know. Man's tinkering with 'Nature' ... deforestation ... pollution ... global warming ... climate change leading to mutations ... evolution -- originated in insects many million years ago and at some point of evolution developed the ability to infect other species ... insects, birds, bats, animals moving out from deep forests into human habitation due to environmental compulsions created by man ... vulnerability due to the emergence of modern bad lifestyle ...
Perhaps, many viruses started their global journey from African rain forests, striking terror across the world. Some originated in China. We have interfered too much with 'Nature', intruding into the forests and causing 'tropical biosphere devastation' leading to ecological imbalance which may be the cause for the emergence of new dangerous (Biosafety Level 4) microbes. International travel promotes the spread of infections wide and fast.
Global warming may melt the polar icecaps / permafrost and bring out the hitherto 'sleeping' and frozen 'ancient' viruses as 'new' viruses ! we have changed the climate -- too much heat - drought, too much rain - floods, and so on. Warming temperatures favour growth of disease causing vectors such as mosquitoes and ticks which carry agents like Zika, Yellow Fever and Dengue viruses in places which were previously inhospitable to them. And, curiously, shifting weather patterns in warm and rain-fed areas may lead to 'intermingling' of different viruses inside mosquitoes to give birth to a hitherto unknown and untreatable pathogen. Floods in Kerala in 2018 caused Leptospirosis or Rat Fever across the State. Unusually heavy rains promoted bats and Ebola virus. Rodent populations multiply faster when drought forces predatory birds and animals to migrate in search of water and food, resulting in Hantavirus and other epidemics. Changes in climate and agricultural environment made African villagers consume more of ‘bushmeat’, such as bats suspected to be a CoV virus host, leading to Ebola virus outbreaks. The list is endless.
Future is bleak -- The 7.3 billion world population is expected to bloat to around 10 billion by 2050; more accommodation and more food would be needed; deforestation; concrete jungles; bigger predators are either killed or migrate; smaller creatures that host killer pathogens flourish; crowding and urbanisation; bad lifestyle; diseases shine !!!
This virus has been catching headlines during January 2020. This is a 'novel' (new) virus identified in China in Wuhan City in December 2019 which belongs to the 'Coronavirus' family which includes the deadly 'SARS virus', 'MERS virus' and the 'common cold virus' as well. It was identified by 'sequencing the genome', a speedy and laudable research finding by China. China shared the whole genome sequence with WHO and GISAID. This virus causes respiratory and lung infections just as many other viruses. Screening and quarantine in some airports is initiated. Many countries have given travel advisory and warnings about this infection. This virus may snowball into epidemics, and may be into a pandemic. According to the Global Health Security Index (October 2019), most countries are not prepared for the outbreaks of infections like this. India ranks 57th among 100 countries.
Some known new / dangerous microbes are: Marburg virus (MARV), Ravn (RAVV), Nipah virus, Japanese Encephalitis, Naegleria (brain-eating amoeba, Cryptococcosis, Hanta viruses, Hendra virus, Helminths virus, MERS-CoV, NDM-1, A/H1 N1 flu, SARS, Ebola, etc. There must be a number of unknown microbes infecting / killing people around the globe. We just can't diagnose these cases, and often give them wrong diagnostic labels. Also of concern is the possibility of activity in re-engineering and mutating contagious viruses for the purpose of biowarfare. There are reports in media of a secret Chinese facility near Wuhan experimenting with germ studies. Is this new coronavirus a fall out of a biowarfare gone awry ?
The virus issue has become an international political issue too with tensions ratcheted up between Washington and Beijing as they trade barbs over the origin of the virus.
HARMLESS MUTANTS are welcome, not D614G strains. Doctor is afraid of seeing a patient. Patient is afraid of being tested. Everybody is afraid of quarantine, social stigma and sudden death. Employee is scared of going for work. Employer is worried about closure of his establishment if an employee tests positive. We are afraid of each other. For how long more ? -- August 18, 2020
It is high time that we sit up and act to preserve ecology, biodiversity, environment and climate. COVID-19 would have served its purpose if we learnt the importance of NATURE. We claim to follow the writ of ancient India, but follow the modern materialistic philosophy. The ancient values and the contemporary political will have been replaced by GREED.
ECONOMIC DISASTERS
Aside the loss of life, there has been a staggering economic loss. In August 2020, U.K.crashed into its largest recession on record, first time in 11 years -- contracting by a record of 20.4% in the second quarter owing to Covid-19 lockdown.
On 02.02.2020, the headlines in media were of the longest (160 minutes) Budget Speech by the Finance Minister Nirmala Sitharaman and the debates on national economics. All these would pale into insignificance if the 2019-nCoV strikes hard on India. China incurred a loss of $18 billion due to SARS virus in 2002. With 41 million people in the 'lockdown' state, China is poised to lose a staggering hundreds of billions of dollars, according to an estimate ! Zika virus outbreaks cost Latin America and Caribbean $18 billion in 2017; to control the Ebola virus epidemic $5 billion were required in West Africa in 2014; a swift penetration of a viral respiratory disease in the world can wipe out more than10% of the world's economy and kill millions of people ! India may initially lose more than Rs.4 lakh crore or roughly twice the national agriculture budget of 2019-20 !!! International tourism industry could shrink by 70% with a loss of $1.2 trillion !
It is reported that China is also having the problem to deal with another virus disease outbreak -- a "highly pathogenic" strain of Birdflu or H5N1.
March 2020: 1. Flight - Mumbai to Singapore - the 256-seater plane had just 25 passengers ! 2. Flight - Mumbai to London return ticket -Rs. 80,000 ticket was just for 46,000 !
There was only one passenger on the American Airlines flight 4511 from Washington Reagan National Airport to New Orleans on April 3, 2020 !
May 19, 2020: Japan, world's 3rd-largest economy, falls into a recession for the first time since 2015.
It is reported that China is also having the problem to deal with another virus disease outbreak -- a "highly pathogenic" strain of Birdflu or H5N1.
March 2020: 1. Flight - Mumbai to Singapore - the 256-seater plane had just 25 passengers ! 2. Flight - Mumbai to London return ticket -Rs. 80,000 ticket was just for 46,000 !
There was only one passenger on the American Airlines flight 4511 from Washington Reagan National Airport to New Orleans on April 3, 2020 !
May 19, 2020: Japan, world's 3rd-largest economy, falls into a recession for the first time since 2015.
FAKE INFORMATION
No other disease had generated so much of fake news, rumours and misinformation than Coronavirus COVID-19. Honestly speaking, we don't have much of proven facts about this disease. This is the exact reason for the great bulk of misinformation about it on the Internet. While the scientific world is struggling to find facts about this new virus, innumerable preventive and curative suggestions are made with no scientific proof. Millions of dollars are being spent on products of unproved efficacy. During the past one month, you would have seen innumerable suggestions of "eat this" and "don't eat this" on the Net. Tall claims were made by alternative systems of medicine, though with no verifiable scientific proof. Many of the suggested food items or medicinal supplements may, of course, boost immunity in a general way -- but nothing very specific to this virus. And some of the misinformation lead to a needless scare about certain things like newspapers, chicken, etc. And it also promoted some drugs, vitamins, minerals, cow's urine, tea, bananas, etc. as preventive agents against COVID-19.
If you think newspapers carry the virus, it's better you go to Arctic and live in an igloo ! Theoretically, anything may carry the virus. It's the quantum of 'viral load' that's more important. Let's not dream to be in Utopia. Let's develop a sense of proportion. In our panic mood, we are doing so many things like rejecting broiler chicken, washing people with sodium hypochlorite solution, pushing them through 'disinfectant tunnels', and drinking cow urine.
SOOTHSAYERS and AUGURS
And curiously a lot of material has appeared on the Internet of predictions and prophecies -- Nostradamus, Sylvia Browne, et al. They continue to arouse people's imagination to make one convinced of the link between this global epidemic and the predictions made long long ago. Due to uncertainties and vicissitudes in life, man hobbles through the life with the help of the crutches of the unseen and unbelievable. A lot of predictions about corona devastation have come up. You may be interested to read what is quoted in the newspaper clipping attached above.
When are we going to eradicate this new virus ? Perhaps, we may not be able to do. Like H1N1 virus and TB this also may become an uninvited permanent guest. The mortality due to H1N1 (swine flu) virus over the past several years has been still high in India. 1,218 people died in 2019 in India due to swine flu. About 20,000 people die every day in India due to various diseases -- 5,000 due to heart disease, 2,000 due to brain disease. And, 1,000 people are dying everyday in India due to Tuberculosis (TB) which is still the world's single most lethal infectious disease, killing 1.5 million worldwide (2018), 220,000 of whom were in India (and 27%of them are drug resistant). Click on:
https://www.thehindu.com/
OPTIMISM
Don't be scared, my dear friends. It's not all doom and gloom. New diseases periodically make sensational headlines though they may not cause as much harm as the existing ones. The sensation with the coronavirus is the speed with which it demolished the defence of the sophisticated West. The fashion is to talk about new diseases while ignoring the old diseases which cause more economic damage in the long term and kill more number of people. Tuberculosis (TB) is an example. In the laid-back India, 1,000 persons are dying every day due to TB. And now, the most dangerous drug-resistant TB, the XDR-TB (resistant to almost all the available drugs) is emerging. God, save us ! I wrote 43 years ago (Apr. 28, 1977) in THE HINDU that "development of drug resistance, which is a result of inadequate and irregular treatment mostly, has far-reaching implications and if unchecked would make tuberculosis totally unmanageable by the present methods in course of time, whatever be the means."
When are we going to eradicate this new virus ? Perhaps, we may not be able to do. Like H1N1 virus and TB this also may become an uninvited permanent guest. The mortality due to H1N1 (swine flu) virus over the past several years has been still high in India. 1,218 people died in 2019 in India due to swine flu. About 20,000 people die every day in India due to various diseases -- 5,000 due to heart disease, 2,000 due to brain disease. And, 1,000 people are dying everyday in India due to Tuberculosis (TB) which is still the world's single most lethal infectious disease, killing 1.5 million worldwide (2018), 220,000 of whom were in India (and 27%of them are drug resistant). Click on:
https://www.thehindu.com/
Don't get panicked about Miss Corona who killed only around 100,000 in the whole world so far (10.04.2020), but the fear of an invisible enemy in the very air that we breathe is primal. It is the nature's way of balancing life on the planet. Move on, my dear ones !
-----------------------------------------------------------------------
If you wish to have more detailed and categorised information on COVID-19, as in
-----------------------------------------------------------------------
Just see what I wrote in January 2020:
As on 22.01.2020 … The CHINA VIRUS is fuelling fears of a major outbreak as millions travel for the LUNAR NEW YEAR holiday which begins later this week in China, as this virus is related to the deadly SARS virus which killed about 650 people across mainland China and Hong Kong in 2002 - 2003. One more person has died (third person). Now, it looks like it may be transmitted from human to human. Fourteen medical personnel helping the victims of this virus were also infected. Wuhan city in China has 11 million inhabitants and serves as a major transport hub. They are all at greater risk and may transmit the virus to other countries. Some international airports in India are already screening the passengers with thermal scanners. We have to wait and see how the scenario unfolds over the next few weeks.
-- T. Rama Prasad
-- T. Rama Prasad
As on 24.01.2020 … The death toll has alarmingly increased to 26 in China. Korea, US, Taiwan, Hong Kong, Singapore & Vietnam also identified cases. The total number of cases reported has quickly rose to 834, raising concerns in the middle of a major holiday travel rush of hundreds of millions of people cris-crossing China to celebrate the Lunar New Year. WHO is considering to declare the situation as a 'Public Health Emergency of International Concern'. This 'China virus' is coded as '2019-nCoV-218'. Nations across the Asia-Pacific region stepped up checks of passengers at airports. -- T. Rama Prasad.
---------------------------------------------------------------------------------------------
As on 10.04.2020, it is heartening to see that the government and the people are coming together to fight the monumental and formidable public health crisis through a 'LOCKDOWN'. But, India is highly vulnerable to an outbreak, given its large population and the creaky health infrastructure. There are critical weaknesses in India's health care system that may prevent a credible response to our efforts to contain COVID-19. NATURE is great. Let's hope for the best with our NATURAL INDIAN IMMUNITY AND SOLIDARITY.
God, bless us all !
That's what I wrote on 10.04.2020. Now, as on 05.08.2020, read the "letter" by Charles Darwin which is "reprinted" in the first few pages.
------------------------------------------------------------------------------
-- Dr. T. Rama Prasad, www.rama-scribbles.com
PAY WHAT YOU CAN Clinic, Perundurai.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
3 comments:
Subscribe to: Posts (Atom)
Sir, Corona virus Covid 19 is not To be blamed at all. Mankind is just being too foolish to intrude into safe zones of viruses, fungi and deadly microbes, that are in animals, protected by Nature. Man cannot play with Mother Nature. Nature always punishes and wins every time humanity acts stupidly. Thanks for your humorous write.
ReplyLearnt a lot....I wish to request you my dear Doctor the virus vs salt....what is the base for virus ...any element ....I develop halophilic bacteria in salinity of 24% sea water 3.5% to develop metabolic heat to evaporate sea water..by developing pigments ....I have to sit again read your article yet seeking some information on virus vs salt...Regards
ReplyRahman
One of the best articles I have read on this theme and having balance, measure and proportion. Miss Corona in hindsight is really kind and benign in a sense - Nature has rolled a dice with fatality of 2-3%. She is under no obligation not to roll a dice of fatality 40,50,60% with Mr. Corona being "size zero" and "air-borne". Consider what would have happened ?
Dr. Prasad is one of the few doctors whom I know who fall into the rare category of "healers". A healer knows the art, science and commerce of healing, i.e. allowing the innate immunity of the body to manifest itself.
One should be very careful and critical about three things in the world : Big Pharma, Big Government, Big Science. In the proverbial Kali-Yuga, all three converge with overlapped agendas and sometimes not with the best interest in mind of the end users : patients, citizens, learners.
Finally, this pandemic will also pass. The system will come to a new equilibrium. But I think a whole generation will carry this impression forward and may become saner with this.
I nurture another hope : just like pivotal events propel a whole generation (Apollo Mission and interest in space science), this may inspire many young Indians to shift their focus into public healthcare, virology, immunology, public immunity, psychological counseling and learning the art and science of healing.
Again, it was very nice to find an article of this time in the avalanche of printed words in this theme.
Continue your good work.
Tests for Oxygen Desaturation in COVID-19
“HAPPY HYPOXIA” or ‘silent hypoxia’ or ‘latent hypoxia’ killed many during the ‘corona pandemic’ across the world. Hypoxia means a degree of oxygen saturation (SpO2) of less than 94% or a drop of more than 3% from the base line. This can be determined by subjecting the patient to a specified simple physical exercise (like walking / sit and stand)
And, 'syndemics' (combination of epidemics due to different microbes) may add their own might to our misery.
and measuring the SpO2 and some other parameters. This test can be carried out in an ordinary clinical set up by a health worker. A global assessment of the cardio-pulmonary reserves and the cardio-respiratory effort tolerance is possible with this oxygen desaturation test. The test may also predict the anaerobic threshold which is a reflection of the combined efficiency of heart, lung and circulation and marks the onset of anaerobic metabolism due to oxygen deficit.
During this pandemic, clinical condition of seemingly stable patients deteriorated rapidly resulting in unexpected fatalities. One typical example is the legendary singer, SPB who walked into a corporate hospital with only mild symptoms, but couldn’t come out alive despite ECMR intervention. Chest computerized tomography (CT) imaging abnormalities may occur even in mostly asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral extensive ground-glass opacities in the lungs within a few days. And, in about a week, severe hypoxemia necessitating ICU care may supervene. One of the important clinical parameters is to identify this critical hypoxia early to initiate a higher level of care at the earliest. The rationale of this simple and limited testing of overall function of lungs, heart and circulation is to identify those among mild cases of COVID-19 that are likely to progress to severe illness and transfer them to a higher level of care. The risk-stratification strategy and other suggestions in this paper rely on the application of Bayesian principles in clinical care. The tests may be modified and varied depending on experience and results. Given the paucity of understanding of the dynamics of COVID-19 as of today, nothing can be rigid or dogmatic as everything that is being done in the field of COVID-19 is mostly based on best guesses ! Real world cohorts and algorithms are still in the process of evolution.
The quirky aspect of this hypoxia in COVID-19 is that the patient may feel apparently comfortable with no hypoxia at rest, but may become disproportionally hypoxic and breathless on even mild physical exertion. Hence there is a dire need to ‘risk-stratify’ those likely to recover uneventfully from those most likely to require advanced medical care. Every one of the huge numbers can’t be evaluated by advanced technology and immediately. This situation calls for a cost-effective, reliable and simple screening test. It is here in this context that the simple oxygen desaturation tests fit in to measure inducible hypoxia. If appropriate escalation of level of care and treatment is initiated at this stage based on the results of these simple tests, numerous lives can be saved.
During the past eight months (March to October 2020), there has been a new problem of BREATHLESSNESS and FATIGUE at rest or on exertion, and before, during or after treatment for COVID-19. These symptoms have become more pronounced during this period in ‘non-Covid’ cases (like COPD, asthma and other lung diseases), perhaps, owing to interruption in treatment schedules due to lockdowns. The presently available data indicate that in patients recovered from COVID-19, the shortness of breath and fatigue are going to be a huge chronic problem in the decades to come. Already, some ‘Covid respiratory rehabilitation centres’ have sprung up anticipating a humongous deluge of respiratory cripples.
Breathlessness and fatigue may be an expression of disruption of pulmonary and cardiac function. Breathlessness in COVID-19 is not as simple to explain away as in the cases of COPD, asthma or interstitial lung disease (idiopathic pulmonary fibrosis) which are diseases mostly of ventilation. On the other hand, in COVID-19, the patients may have near normal ventilation but have significant problems with perfusion and oxygen diffusion because of the inflammatory pneumonitis rather than the classical pneumonia 12. There seems to be two main handicaps -- heart’s inability to step up cardiac output and lung’s incapacity to maintain diffusion due to infiltration by COVID-19 and / or due to alveolar capillary micro thrombi in the pulmonary circulation (pulmonary vascular endothilitis). The COVID-19 may be comparable to pneumocystis carinii pneumonia (PCP) which shares the features of pathophysiology, acuteness, silent hypoxia, cough, exertional desaturation and CT scan abnormalities. Both these are diseases mostly of perfusion, not ventilation. Most importantly, exertional oxygen desaturation may be demonstrated in most of the cases of COVID-19 in contrast to cases of bacterial pneumonia, tuberculosis and pulmonary candidiasis which may not so clearly show up the desaturation 13.
As such, COVID-19 is a peculiar disease characterized by a tendency for oxygen desaturation on minimal exertion disproportional to breathlessness. That’s why we see cases of “happy hypoxia” and sudden deaths in patients who are not seriously ill apparently. It is increasingly becoming clear that many patients have normal pulse oximetry at rest but their readings deteriorate on exertion. A fall of 3% or more in pulse oximetry on exercise is a warning signal for intensive care. Many of the existing patients of chronic lung diseases are an easy prey for a devastating superinfection by COVID-19. And the cardio-respiratory functions of this segment of the population deteriorate rapidly when attached by the SARS-CoV-2 virus. It is in this context that ‘TESTS for OXYGEN DESATURATION’ come to the fore to identify potentially serious underlying abnormality and thus save lives through early interventions, not only of COVID-19 victims but also of the other chronically ill cripples.
Available are very sophisticated and hugely expensive tests to determine exertional oxygen desaturation and objective evaluation of functional exercise capacity – pulmonary function, cardio-pulmonary stress evaluation, blood gas analysis, etc. They provide a very complete high-tech assessment of all the systems involved in exercise performance. The downside of them, obviously, is that they are unreachable both by distance and money for most of the population in the vast swathes of the country.
What is practicable and desirable is to make use of the simple and inexpensive tests for oxygen desaturation which are already in use to monitor and manage chronic lung diseases over time. Some studies reported good correlation between these tests and the complex cardiopulmonary exercise testing / ‘peak oxygen uptake’ (r = 0.73) 36, 37 . Moreover, a study indicated that these tests provide information that may be a better index of the patient’s ability to perform daily activities than is ‘peak oxygen uptake’ assessment38. These simple tests may be modified according to experience as they are not yet widely validated for use in COVID-19. These would serve the purpose of identifying the vulnerable and initiate intensive treatment to save lives. In addition, most of these tests do not require sophisticated emergency backup, as serious complications due to testing are unlikely to occur. A couple of them may be even done at home by the patients themselves. I have got numerous tests done at my patients’ homes through online consultations with gratifying outcomes.
Some of these tests are:
(1) 6 MWT / 2 MWT
(2) 1 STST
(3) 15 step climbing
(4) 40 step Walk Test
(5) 10 minute Cycling Test
6 MWT is the abbreviation for ‘6 minutes walk test’. This test measures the oxygen saturation (SpO2) before and after the walking, and the distance that a person can quickly walk at his own comfortable pace on a flat, hard indoor surface in a period of 6 minutes in a room or corridor. The patient may vary his speed and may even walk intermittently according to his capacity during the six minutes. It also records pulse, respiratory rate, blood pressure, and grading of dyspnea and fatigue (using the Borg scale), at the beginning and end of the walking. ECG recording may also be done, if the facility is available. This self-paced test assesses the submaximal level of functional capacity and would be useful in evaluating cases of COVID-19, COPD, asthma and other diseases involving lung and heart. It also would be useful to certify fitness to discharge a patient. This test is more dependable to assess hypoxia than protocols developed for risk stratification than ‘National Early Warning Signs 2 (NEWS 2) or SOFA score. Full details of the classic 6 MWT may be found in the American Thoracic Society Statement : Guidelines for Six-minute walk test 6. The value of the 6 MWT in COVID-19 is to identify patients who are not hypoxic at rest, but become hypoxic (silent hypoxia) on doing 6 MWT. Patients whose SpO2 is less than 94% should straight away be referred for higher care without doing 6 MWT. So also, the patients who are breathless at rest, known patients of unstable angina, valvular heart disease or Eisenmenger’s syndrome may be sent to specialists without doing the 6 MWT. If the patient becomes very breathless, sweaty or giddy during the procedure, the test is to be aborted. The test may be done for three minutes if the patient is above 60 or is weak. Though the test can safely be done by a health worker, availability of a physician nearby is desirable for emergency care. All the parameters cited above must be recorded on a form. The test is considered positive for hypoxia if the SpO2 drops to below 94% or drops by 3% or more from baseline. The other parameter is the distance walked in six minutes.
There is a variant of this 6 MWT called ‘Shuttle Walk Test’ during which the patient is to walk up and down a 10-metre distance at increasing speeds until he gets too breathless to continue. This requires medical supervision and emergency care facilities.