COVID diary 24/03/2020

Globally, the total number of cases continues to rise alarmingly, nearly 400K now. The rise from 300K has been very quick. My prediction of Italy’s new case numbers was spot on

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The above proves that a lockdown  -even incomplete is important for the control of spread of the virus. Italy went into lockdown on 9th March and exactly 2 weeks later, we have the reduction in numbers. Lesson for all nations- shut down without delay if you are not well prepared.

Today,  The idea of our GP clinics team worked well today. The group had made a plan that potentially infectious patients with respiratory symptoms to be brought only after 3 pm so as to minimise the exposure to us and to vulnerable patients like elderly and with past medical problems. Yesterday, I  decided that I will call all such patients before they enter the clinic premises. I had realised that most of the patients didnt need to be examined at all. Some needed reassurance and some needed medical certificates to stay off work which were printed and handed over to them in their cars thus minimising our expsoure to them as well to other patients.

Today, other doctors raised the concerns about the exposure to such patients. I told them about what I had done yesterday and we adopted the same idea to be implemented for all doctors. In total. all the 4 doctors had about 30 patients with flu like sympotms but the number of patients who needed to come in to be examined was only 2-3.

The group has incidentally had planned to start the same process from next week when telehealth consultations becomes the norm and all consultations are eligible without any conditions.

 

Today, the Western Australian government did suggest that a change is on the cards to the testing criteria which might come in force soon. Quite ridiculous that they havent changed since 12th March ( WA had less than 14 cases then) . At the time, it was considered that people returning from overseas were higher risk and so with the shortage of testing kits, they justified the criteria that anyone with symptoms and overseas return in 2 weeks or positive contact with COVID positive case are eligible. Since all of the initial cases identified then were oversease returnees, this set of criteria has been biased towards picking only that cohort for testing and hence , I feel that there are lots of negative results , but if and when the testing criteria are relaxed and people in the  community with symptoms are tested , I am sure the numbers will soar.

This is how it is now. If I was an office worker who had a minimal sorethroat and some weakness and have returned from New Zealand on 12th March, I can get tested. But on the other hand, my friend who has been quite unwell with cough, shortness of breath , high grade fever for 2 weeks and who works in a restaurant and who has returned from Sydney last week is not eligible for a test. To put things in perspective, NZ has 155 cases today and NSW has 818 cases. Why the criteria have not changed for so long is beyond me. By the time they detect local cases in  community, it might be too late.

 

Regarding Australia and India , the differences in messsaging and steps taken continue as yesterday.

Scott Morrison continues to give precedence to economy than dealing with the looming health crisis. He states that more restrictions will be in place and indeed some restrictions have been brought about but still lacks the decisive punch that is needed. Schools still remain open, as do supermarkets.  ScoMo suggested ” If anyone has a job and is doing it, it is an essential service”. Poor resolve in managing the situation. The chief medical expert Dr Brendan Murphy is weak and seems manipulated to parrot the line of the politiical leadership

On the other hand, India is dealing with things firmly. Several incidents of complete lockdown of day to day activities, exams postponed. No excuses made. NaMo addressed the nation in the evening and ordered a 3 week lockdown and curfew and ordered for everyone to stay at home . ” Jaan hai to jahaan” hai. Loosely translated, it means only if you have a life, then you can enjoy it,  -something which the western leaders in UK. Australia and others have taken a long time to realise and still not done.

 

 

COVID diary 24/03/2020

COVID diary 23/03/2020

Monday clinic – Most of the patients were for non COVID related issues. But some were for respiratory symptoms which could be any viral infection or COVID. People coming in with typical viral sympotms and febrile but cant be tested for COVID because they dont meet the criteria of foreign travel or having had direct contact. The WA public health reports only 2 people of the 148 for whom the source of infection is not known. I am sure that if they relaxed the criteria and tested more in community, the numbers will soar.

Coming to the blog I wrote about the similarities of India and Australia’s positions in the curve of new cases and deaths, I cant believe how different the responses of both governments have been today.

Australian govt ( akin to the UK government ) has continued to be worried more about economy, the jobs, the self employed , the bail outs etc.  The leadership seems to be more occupied about the economic fallout of the crisis rather than addressing how the crisis could be averted or its impact reduced. For them , the issue of livelihoods still trumps that of lives. The Australian government has banned pubs , bars etc but still has falled way too short of ordering a lockdown.  For many, life still goes on as usual. There has been mixed messaging and confusion coming from the leaders. Although the PM suggested schools will remain open, the premeirs of other states have issued separate statements either suggesting that is advised not to attend school or in Victorias case- closed schools from Tuesday

On the other hand, the Indian government incuding the state governments have buried their political differences, and acted unitedly and decisively. The entire rail network and flight network will stop. Many states have imposed curfew and huge penalties for breaking the lockdown exist. There is absolutely no dithering on how the problem should be addressed. Lets see how it goes.

Among other news, Californian beaches were filled with people, thus proving- Stupidity is universal.

Had another meeting with the GP team of our group. Interesting times ahead. Some challenges remain. The government still hasnt opened up all the consultations for telehealth. Seems a no-brainer. In such a pandemic of an infectious disease with a very easily infectious virus, one would have thought limiting the movement of potentially infectious people is vital and hence, GP consultations with such people would be made eligible for telehealth. But no, medicare in its wisdom still wants a 65 year old with fever,  sneezing and coughing to come out of the house, wait in the waiting area in the clinic, see his GP  , potentially putting the GP and other vulnerable patients at risk of either flu or COVID – whatever he has.

The Australian government had no hesitation in announcing a 66 billion dollar bailout package to the industry  a significant proportion of which might be gobbled up CEOs and top management of blue chip companies but will drag its feet to make all GP teleconsults eligible for telehealth billing – the overall cost of which might be in the few millions.

Spoke to a friend in USA- seems situation is grim already there. 44 yr old fit and well ER physician went onto ventilator yday and succumbed today.  😦

 

 

 

 

COVID diary 23/03/2020

Tackling the pandemic – lessons for India and Australia

As of today, fortunately, Australia and India are behind some of the countries badly affected by the novel Corona virus disease.

However, it is going to be a big issue for both the countries in the coming few months. In order to hoist a good response to the challenge of the virus, it is important to learn from the experience of other countries and see if we could use the good practices and avoid their mistakes.

I address 3 key issues here which I feel are important in getting the disease under control

1) Lock down

China did it quickly,
Italy gave mixed messages initially, delayed it
Spain delayed it
South Korea and Singapore didn’t do it fully (but they did aggressive testing, contact tracing and effective quarantining)
UK faffed around with it, eventually heading towards complete lockdown now.

        The experience of the numbers in the above countries suggests strongly that we need to lockdown and we need to do it NOW.

Not advisories, not suggestions, not gentle taps.

Firm, Assertive, strict, clear messaging

Only one message – STAY AT HOME.

The fact that we are not doing what Singapore and South Korea did with respect to testing and contact tracing should discourage us from using their examples with respect to school closures

Lockdown will give us advantage of time, at least a few weeks.

  1. We can plan better
  2. Organise better
  3. Get more staff, ventilators, masks, swabs, reagent for testing and also some toilet paper and hand sanitiser!

And when we are better prepared, lockdown can be eased and if the number of cases rises, we will be in a better situation to cope and manage them.

 

2) Testing-

The countries which tested aggressively have fared better. Our testing has been far from ideal. Head line numbers in Australia look good. Very little percentage of positive results. But a closer analysis reveals that the testing criteria are so rigid to identify any community spread that it is impossible to get tested. The test criteria have virtually excluded the people in the community with suspicious symptoms. Overseas travellers with minimal symptoms have had the tests and made up the large number of negative results.

India has had limited testing compared to the population and definitely cost is a factor so is the fragmented health care system.

If testing improves, then I am sure the numbers in Australia and India will be much worse.

 

3) Management of healthcare workforce

In any such pandemics, the number of trained healthcare workers is a key parameter which will dictate the outcome.  As such, the number of workers needed is high in such scenarios. Also, the pressures worsen if workers contract the infection (which they are more likely to) and have to self-isolate.

This is a good article analysing why it is important to keep the healthcare staff protected and how to go about it.

The healthcare workers need to play their part in washing hands and using appropriate Personal Protection Equipment so as to make sure they don’t get infected.  The governments need to play their part by making the PPE and the appropriate infrastructure available to the staff.

Tackling the pandemic – lessons for India and Australia

COVID diary 22/03/2020

Got up and spending time pretty much same as yesterday

Overnight, realised that 790 people have died in 1 day in Italy – the biggest death number in a day

Saw ScoMo and treasury secretary- addressing the press this morning. Dont know the thinking of these people.

They announced a 66 billlion dollars infusion into the economy.  All the discussion into saving jobs, maintaining the economy, how to support people with small salaries but on the other hand, totally oblivious to the problem. The only  intervention that has worked most effectively until now is a total lockdown – closing of all but the most essential activity. Totally ignoring it, the PM is only giving advisories , suggestions whereas people continue to flock to restaurants and pubs, beaches etc. They need to take a decisive stance to stop everything but they continue to dither and do the same mistakes which countries like Italy and Spain did. I think we need to be ready to face the same consequences.

One of the main justification by the WA govt not to go  for school clsoures or lockdown has been the low numbers of community spread. But the testing criteria are so rigid to identify any community spread that it is imposssible to get tested. The criteria are you have to have respiratory sympotms and evidence of travel in the last 2 weeks or a definite contact with a COVID positive case.

They have been assuming that all the positive cases have been tracked perfectly for all their period of infectivity and all their movements and potential contacts have been informed which can hardly be the case. Since there are very few people in the community who meet the criteria, many people with respiratory symptoms in the community arent getting tested and that is the only reason for the reduced numbers in WA.

But the government is relying on those numbers to justify not enforcing strict lockdown.

I feel we are having a ticking time bomb. The people who have returned from overseas have been advised to self isolate. They are not being policed and the government assumes they are doing so religiously .

I feel we have many many COVID positive patients in the community but we have excluded them from our testing and hence they are undiagnosed and they are continuing to spread the infection to many more.

By the time, we realise the true numbers, I am sure we will be very late.  Australia is well on the way to be another Italy.

I will be very very sad

 

21:00 ScoMo and the medical advisor had a conference in the evening. They are shutting down pubs and restaurants ( at last!!) but no school closures yet and no total lockdown. Again, economy, jobs and other worries given more precedence than lives. ScoMo very cleverly putting the onus on the medical advisor with respect to school closures

 

 

COVID diary 22/03/2020

The BBC will realize…. some time soon

It is with considerable anguish that I follow the news of 40 CRPF jawans killed in a terrorist attack in Pulwama, Kashmir. Jaish-e-Mohammed,  a well known Islamist terrorist organisation has claimed credit for it.

Jaish-e-Mohammed has been designated by the United Kingdom,US,  Russia, Australia, Canada, India, the United Arab Emirates,and even Pakistan as a terrorist organisation. However, when you look at the coverage of this incident on BBC, nowhere does the term “terror attack” or “terrorists” figure, except in one instance where it reports about the designation by various countries. This glaring reluctance to call this brutal inhuman suicidal fidayeen jihadist attack a “terror” attack outright and also BBC’s coverage of news about Kashmir gives the impression that the unrest in Kashmir is simply due to the local populace being antagonistic to India and hence such events are just natural events of resistance to the security forces of India.

When terror activities happen in Paris or London or anywhere in the Western world, they get great coverage. Every one from New York to Timbuktu feels sad, expresses their solidarity in whatever little way they can; as they should.  Even Indians do candle light vigils and feel for the victims. But when blatant terrorist attacks such as Pulwama  happen in India, I see the western media like BBC hesitant to call it a terrorist attack  and call the perpetrators as “militants” as if it is just a popular uprising against Indian “oppression”.

A time will come when events such as which happen in Kashmir – of stone throwing, public disorder, violence against people of other religion, against law enforcement and security officers will become the norm in some of the cities of United Kingdom. Already, there have been some several areas in some of the big cities of the UK where huge demographic changes have happened, similar to what happened in Kashmir. In the late 90s, Kashmiri pundits from minority Hindu community were driven out of the valley forcefully and suddenly. The changes in UK however, have been gradual and have been more organic.  Having said that, it is only a matter of time, maybe 10-15 years when the demographic changes reach a “critical” point  and the minority community is no longer a minority in certain cities.  That is when, incidents similar to what Kashmir has faced in last couple of decades will become common place.

The BBC will see that many such violent acts will have the backing of huge numbers of their “own” people. And the BBC will then wonder why many of their “own” people have become antagonistic towards the UK. If they do a honest assessment and fact check then, they will realize that the reasons for those incidents and the ones in Kashmir (now) have the same underlying religious jihadi ideology.

I hope that at least then, the BBC will call them terrorists.

I hope that at least then, the BBC will realize that the incident at Pulwama on 14th February was indeed a TERRORIST attack and had to be reported as one.

 

 

 

 

The BBC will realize…. some time soon

A punishment too harsh…

When the news of the cheating and ball tampering by the Australian cricketers first broke out, my response was the same as many. “These arrogant Aussies with their sense of superiority should be brought down and should be handed the harshest punishment “

Definitely, part of the reason for such a feeling was the fact that Australian cricketers of the past  had got away with their  arrogance,  unsportsmanlike behaviour on and off the field and had many a times justified their crass morally repugnant behaviour as an essential ingredient for success on the field. (https://www.youtube.com/watch?v=9Bwn-uAWdoQ)

 

I grew up in times when the Australian cricketers were winning all tournaments but at the same time, behaved as if they could get away with any of their on field behaviour. Seeing Michael Slater admonishing Rahul Dravid for no mistake of his ( https://www.youtube.com/watch?v=j8dkLrm5ALI) and Glenn Mcgrath sledging and gesticulating aggressively to Sarwan (https://www.youtube.com/watch?v=hN4RU4LW2IM) and several such incidents have created an impression about Australian cricketers and an expectation that even when shown their obvious mistakes, the Aussie cricketers will not own up to them and be remorseful.

That is what I expected from the current episode too. I had expected them to continue defending their actions with some weird rationale just like Steve Waugh did about the sledging techniques as a form of “mental disintegration “of the opposition.

But the response from the cricketers has been very refreshing .  Seeing the players in the press conferences after being sent off abruptly from a tour, especially Steve Smith, I can’t feel more sorry for them.

The fact is that they are being penalized for “cheating”. The huge backlash they are receiving from the Australians and the world over is for intentionally trying to cheat.  But then, are they the first?  Are they the worst cheats?

Of course, what they tried to do was in contravention of the rules of the game but then, how many times have we seen players of all sport play within the rules but contrary to the spirit and blatantly cheat in a quest to win at any cost.

  • Aren’t the countless batsmen who know they have nicked the ball to the wicketkeeper but don’t walk not intentionally cheating?
  • Isn’t the fielder who claims a catch even when he knows it is possible that he may have taken it on the bounce not intentionally cheating?
  • Isn’t this an example of intentionally cheating? https://www.youtube.com/watch?v=afQvCaPd4t8
  • Aren’t all these episodes intentionally cheating? https://www.youtube.com/watch?v=rxiBX6D4mxQ
  • Taking examples from other sports, aren’t all those footballers who fall over for no reason without any contact with the tackler only to earn a free kick or penalty not intentionally cheating?

How many of these players have faced such harsh penalties and ignominy as the current trio?

 

I feel Steve Smith and the others are having to face the backlash which is not entirely due to their doing. There is a legacy effect from the previous Australian players and teams. The on field behaviour of the previous teams, their treating of the opposition teams and the players, their arrogant justifications for the same have all been significant factors in creating the frenzy within and outside Australia and had reached a tipping point and unfortunately, Smith, Warner and Bancroft are having to face the punishment for that.

My take is that Lehman had to go as did the players responsible for the decision. But it is debatable whether the quantum of punishment in the form of an international ban for 12 months is appropriate.

 

I for one, feel it is too harsh.

 

 

 

 

A punishment too harsh…

Off to see PM Modi

So, I am going to attend the massive reception of our Prime Minister Shri Narendra Modi at Wembley stadium in London tomorrow.  I am very excited and looking forward to seeing him speak. It is going to be  a record gathering of 50,000 or more people, an enhancement on the numbers he attracted in other parts of the world. In times of increased cynicism with politicians across the world, it is staggering to witness such huge support for a leader of a state.  I am not expecting any fantastic announcements or anything different to what he has said over the last year or so. But I still felt strongly that I should attend the event.  It is evident many others do as well.

Many in the media and the “experts” on TV who were surprised at the amount the mandate he got in 2014, continue to be shocked at the  support he gets from the diaspora . They attribute it to effective “PR machinery” , “rabid Hindutva youth”  “ guilt of leaving motherland” etc., but they couldn’t be further from the truth. None of these would have guaranteed him the consistent support he has had outside the country.

Here are 3 of my reasons which explain the huge attendances.

  • Over the year and half, ordinary people are convinced that he is working for them and not for himself. In a country of largely corrupt and self serving politiicans, people have a firm belief that he untiringly works for the nation. Ordinary people believe him when he says that. Even on Deepavali this year, he was not taking a break but rather visiting the armed forces.  Even when he was observing a fast during the Navratri, his schedule is packed. Despite the much talked foreign tours attracting controversy, people at least on the social media have realised how his schedules are planned and how he tries to get something out of every minute of his stay abroad. When he returns to India, there is no respite. He may not have brought about any dramatic changes on the ground yet, but people believe they will come sooner or later. He may not be undertaking the policies which they think are right, but at least he is not self-serving like the previous regimes.
  • Modi has started to bring some pride to the Indian diaspora which has long been overdue. He talks about our strengths, potential and the immense possibilities. He has made us feel that we will see us and the country marching ahead in future.  Slowly and slightly but surely, the stature of India has grown in the world. In the UK, the contribution of the Indians is increasingly recognised. The diaspora attribute this partly to the recent increased standing of India which in most part is due to the Modi government.
  • Many young Indians feel that he has been vilified for far too long and far too disproportionately for past events, and somewhat unfairly at that. He has gone through an extensive judicial scrutiny closely monitored by no less than the highest court of the country at a time when the Congress party was in power in the centre. We know that they would have not stopped at the smallest opportunity to incriminate him but they didn’t come up with anything. That he faced such a scrutiny as a sitting head of state government is unprecedented but he has come out unscathed. The youth are not convinced anymore with the tenacious narrative that he is complicit churned out by the mainstream media and the left liberals spurned from the Congress- ecosystem. More importantly, despite enjoying enormous unchallenged power in the whole of the state for 10 years and now at the centre for a year and half, I personally cant think of a single incident in word or deed from his side wherein he has discriminated a particular community or which would disturb the communal harmony of the country. This knowledge makes the people doubt his complicity in 2002. Despite this he is still asked repeatedly about his role in 2002.

Many youth feel angry that he is vilified this way and feel the urge to demonstrate their support to him. Hence, they take time off work, travel from far and attend such events as in Wembley in big numbers to make their support known.

And I am one of them.

Off to see PM Modi