Is the “LOCKDOWN MEDICINE” too toxic ?
RAMA PRASAD T.
Dr. T. Rama Prasad,
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre, Perundurai, Tamil Nadu, India.
Presently: Director of ‘PAY WHAT YOU CAN’ Clinic, Perundurai, Erode District, TN – 638052. drtramaprasad@gmail.com
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A MONTHLY JOURNAL OF MEDICINE AND SURGERYSN Vol. 117 No. 10 OCTOBER 2020 ISSN 0003 5998
Indexed in IndMED Email: admin@theantiseptic.in www.theantiseptic.in
5998 • `
A MONTHLY JOURNAL OF MEDICINE AND SURGERYSN
Vol. 117 No. 10 CONTENTS OCTOBER 2020 ISSN 0003 5998 EDITORIAL:
Triglycerides .................................................................................................07 GENERAL:
Omega 3 fatty acids as GRAS! Sanjay Agrawal, Shanaz Khan..............................................08 Dangerous chemicals being used for coating fruits and vegetables
Rishi Kant Gupta, ...11 Is the “Lockdown Medicine” too toxic ? Rama Prasad T. ...............................................13 Empowering Indian women for reproductive rights, Aditi Saxena, ..............................16
A study of Candiduria with Catheter associated Symptomatic urinary tract infection in cases of medical intensive care unit of a tribal, rural tertiary care centre Monalisa Subudhi, Sudhanshu kumar Das, Ashutosh Subudhi, Khetrabasi Subudhi ..............................................22
Biodegradable Bone Screws
Ankita Dubey, Vijay Thawani ................................................24 ALTERNATIVE MEDICINE
Measles: A Clinical Approach Pradnya Bharat Patil, Rahul Nitinalias Ruge .......................27 Dysmenorrhoea Vijayalaxmi Chindak ......................................................................................29 NidanPanchak’:AwayofdiseasediagnosisP
reeti,SanjayKumarSingh..........................32 The Practice of Snana : An Overview
Rashi Dhasmana, Ruby Rani Aggarwal, Sanjay ........35 Concept of pain management by Yoga in anatomical view
Prasad R. Sanagar, Parag.......37 Know your body type through ayurveda
Ashok Yuvraj Mane, Milind Aware ......................39 Study of effect of Yogasana on Central Obesity
Prasad Rangrao Sanagar.......................41 Occasional Review ....46; Gleanings ....47; Glimpse into history ....48
Case of the month .....49; Medi Quiz .......................................................................................50
THE ANTISEPTIC Vol. 117 • October 2020
Is the “LOCKDOWN MEDICINE” too toxic ?
Dr. T. Rama Prasad
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre, Perundurai, Tamil Nadu,
Presently: Director, ‘PAY WHAT YOU CAN’ Clinic, Perundurai, Erode District, TN – 638052.
drtramaprasad@gmail.com
Specially Contributed to "The Antiseptic" Vol. 117 No. 10 & P : 13 - 15
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. To know more about these ostriches, click on: https://www.thehindu.com/opinion/op-ed/the-club-of-virus- deniers/article32071033.ece
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 guard 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. And also, we should remember that the virus killed the economy despite not imposing a lockdown in Sweden, and that lowest mortality rates are logged in by Japan and South Korea without resorting to lockdowns, perhaps due to their culture of mask-wearing. And, more importantly, we should remember that India is a large country with different zones having different timelines of onset of the epidemic. This means that a total lockdown of the whole country would not yield the desired result.
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 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. 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 60,000 people died in eight months in India, as on 24.08.2020, 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 ‘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 ‘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 country-wide 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 this sledgehammer to crack the nut, strict following 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 ‘peak’, ‘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 60,000, 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.
"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
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 routine 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. 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, 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. 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 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 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 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.
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%.
REFERENCE:
1. https://www.iphaonline.org/wp- content/uploads/2020/05/Second- Joint-Statement-of-IPHA-IAPSM-and- IAE-on- COVID-19-containment-plan- May-25-2020_Shorter-version-final.pdf
THE ANTISEPTIC Vol. 117 No. 10 OCTOBER 2020 ISSN 0003 5998
A short list of some of the published articles in The Antiseptic (a premier Medical & surgical journal), The Hindu (a national Newspaper), etc. authored by Dr. T. Rama Prasad.
1.
2. 3. 4. 5. 6. 7. 8. 9.
10. 11. 12. 13.
14.
15.
16.
DIGITAL CLUBBING and HYPERTROPHIC PULMONARY OSTEOARTHROPATHY - Pathogenesis -- The Antiseptic, Vol. 76. pp. 213-215, 1979.
CHILDHOOD TUBERCULOSIS - Part I -- The Antiseptic, Vol. 76, pp. 449 - 504, 1979
CHILDHOOD TUBERCULOSIS - Part II -- The Antiseptic, Vol. 76, pp. 567 - 574, 1979 STEVENS-JOHNSON SYNDROME and THIOACETAZONE -- The Antiseptic, Vol. 77, pp. 99 -102, 1980 HIGHLY PURIFIED INSULINS - An Assessment -- The Antiseptic, Vol. 77, pp. 3455-347, 1980
IS THE "LOCKDOWN MEDICINE" TOO TOXIC ? -- The Antiseptic, Vol.117, No.10, pp. 13 -15, 2020 ANTISEPTICS, DISINFECTANTS and COVID-19 -- The Antiseptic, Vol.117, No.11, pp. 26 - 28, 2020 40+15 HYPOXIA TEST in COVID-19 -- The Antiseptic, Vol.117, No.12, pp.13 –17, 2020
THE CONUNDRUM of COVID-19 VACCINES – The Antiseptic, Vol. 118, No. 1, 2021
HEALTH CHECK-UP: how healthy is it ? - The Hindu, Open Page, January 15, 2012 -- ......http://www.thehindu.com/opinion/open page/article2801701.ece
THE ‘GOOGLE EFFECT’: may be good, may be bad - The Hindu, Open Page, April 22, 2012 -- ...http://www.thehindu.com/opinion/open-page/article3340116.ece
OF TEA, COFFEE and COMMERCE - The Hindu, Open Page, January 12, 2014 --
... http://www.thehindu.com/opinion/openpage/of-tea-coffee-and-commerce/article5567951.ece.
A BAD PATCH - The Hindu, Open Page, March 15, 2020 -- https://www.thehindu.com/opinion/open-page/a-bad-patch/article31069356.ece
YELLOW NAIL SYNDROME - Chest (U.S.A.), Vol. 77, p.580, 1980
https://journal.chestnet.org/article/S0012-3692(16)40458-7/fulltext
YELLOW NAIL SYNDROME - The Indian Journal of Chest Diseases & Allied Sciences, Vol. 22, pp. 69-72, 1980. DRUG RESISTANCE in TUBERCULOSIS - Journal of the Indian Medical Association, Vol. 64, pp. 264-267, 1975.
References to more articles by Dr. T. Rama Prasad may be found in: http://drtramaprasad.blogspot.com www.rama-scribbles.com
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