Wuhan Coronavirus Resource Thread

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sajo
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Re: Wuhan Coronavirus Resource Thread

Postby sajo » 23 Jul 2020 11:43

DrRatnadip wrote:Many elderly pts ( around 60 %) , even those with comorbidities improve relatively well.. Pts who present late i.e those require ventilation within 24 hrs of admission have poor outcome.. I think so called " happy hypoxia " is at play here.. Pt dont realise about gross lung damage untill they feel difficulty in breathing..Such pts present with SpO2 less than 85%.. That is why it is important to monitor oxygen saturation with SpO2 probes..


40% bad outcomes in elderly (I am assuming 60+) is still quite worrying, as I have mildly hypertensive and mildly hypertensive+COPD in the immediate family. I have ordered a fingertip Oximeter, which, incidentally seem to be selling at 3x-4x their earlier prices, which is yet to be delivered. But then I think, what would I do even if I find something off in the oximeter reading? There are no beds available anywhere, unless one has serious money+Clout, which as a mango abdul, I dont. There is a PMC dashboard, which news reports are saying are not in-sync.
Very clearly, the MH administration does not know what to do when presented with a bill after eating happily for years.

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Re: Wuhan Coronavirus Resource Thread

Postby SRoy » 23 Jul 2020 12:11

COVID19 effect on mortality rate will be known much later.

Researchers will have to collect data from all states and UT municipalities and do a Y2Y comparison. All wrong attributions will get reconciled.
So, at present a clear picture is not possible.
Not anybody's fault, but things are very chaotic and ad hoc at ground levels.
That's the way things are.

Till the time we get thoroughly researched and verified numbers, we can do without the self appointed Goebbels.

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Re: Wuhan Coronavirus Resource Thread

Postby greatde » 23 Jul 2020 12:27

Are discharged patients kept under some kind of quarantine? Some discharged patients have seemingly been re-admitted and thus, they still do carry (low) viral load? That can be an infection source for the rest, and the recovery process isn't that simple nor easy?

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Re: Wuhan Coronavirus Resource Thread

Postby Mollick.R » 23 Jul 2020 13:14

Bengaluru: Sent back by three hospitals, Covid doctor loses 28-day battle to virus
Sunitha Rao R | TNN | Updated: Jul 23, 2020, 09:57 IST

BENGALURU: A 50-year-old Covid-19 warrior doctor, who had been refused admission by three private hospitals, succumbed to the virus at a hospital of Bangalore Medical College and Research Institute (BMCRI) on Thursday.
Dr Manjunath ST was on Covid-19 duty at Chikkamudavadi primary health centre in Kanakapura taluk, Ramanagara district, when he contracted the virus. He was the second member of his family to succumb to the virus; his father-in-law died two days ago.
Dr Nagendra Kumar, a medical officer with the BBMP, told TOI that his brother-in-law Dr Manjunath developed high fever and breathlessness on June 25. “It was a suspected case, and he was awaiting his test report. We, doctors, could not get a bed for him in three private hospitals we went to. All three hospitals rejected admission as he didn’t have his Covid-19 test report,” Dr Nagendra said.
After the first hospital rejected admission, the latter ones asked why the previous hospital had done so before taking the same decision.

“Finally, four of us sat on the road in front of a fourth private hospital in Kumaraswamy Layout after which he was admitted on June 25. His condition improved for a while before it began deteriorating and we shifted him to the BMCRI on July 9. He was on ventilator. The doctors had said his lung wasn’t expanding and he required to be in the prone position, but that was not done,” said Dr Nagendra.
Six members of doc’s family were positive
According to Dr Nagendra, Dr Manjunath required the assistance of a physiotherapist to be put in the prone position, and no physiotherapist agreed to wear PPE and enter the Covid ICU. “We sought help of a private physiotherapist, who could have helped my brother-in-law and the man agreed to come. BMCRI approval for the same was under process,” he explained.

Six members of Dr Manjunath’s joint family have tested positive. They include his dentist-wife and their 14-year-old son, who have since recovered. “Our families suffered because we are doctors. We should have been labourers instead,” said Dr Nagendra, who was seen waiting for Dr Manjunath’s body in front of Victoria Hospital mortuary on Wednesday.
Dr Om Prakash Patil, director, health and family welfare department, said he was aware of the demise of Dr Manjunath and was collecting more details.

https://timesofindia.indiatimes.com/city/bengaluru/bengaluru-sent-back-by-three-hospitals-covid-doctor-loses-28-day-battle-to-virus/articleshow/77118116.cms

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 23 Jul 2020 13:28

^^ sad news.. RIP brave doctor..

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 23 Jul 2020 13:39

greatde wrote:Are discharged patients kept under some kind of quarantine? Some discharged patients have seemingly been re-admitted and thus, they still do carry (low) viral load? That can be an infection source for the rest, and the recovery process isn't that simple nor easy?


Discharged pts are advised home quarantine for 2 wks.. Low viral load in discharged pts is possible.. Decision to discharge depends on clinical picture and not total viral clearance.. Readmissions are not very common..

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Re: Wuhan Coronavirus Resource Thread

Postby Zynda » 23 Jul 2020 20:03

sajo wrote:Very clearly, the MH administration does not know what to do when presented with a bill after eating happily for years.

It seems like many state governments all over India are struggling. Look @ BLR as well...I think an article about a front line Doctor dying due to being denied by Private Hospitals due to lack of Covid certificate was posted in this page.

DrRatnadip wrote:I am taking HCQ since pandemic started and by God's grace I haven't got infection, that too after constant exposure in Covid ICU

If you don't mind, want to ask a personal question about safety. How are you making sure that your family members are protected (from you)? Do you stay in an isolated room?

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 23 Jul 2020 20:59

Zynda wrote:
sajo wrote:Very clearly, the MH administration does not know what to do when presented with a bill after eating happily for years.

It seems like many state governments all over India are struggling. Look @ BLR as well...I think an article about a front line Doctor dying due to being denied by Private Hospitals due to lack of Covid certificate was posted in this page.

DrRatnadip wrote:I am taking HCQ since pandemic started and by God's grace I haven't got infection, that too after constant exposure in Covid ICU

If you don't mind, want to ask a personal question about safety. How are you making sure that your family members are protected (from you)? Do you stay in an isolated room?


I have met my parents only once since march.. Before meeting them I did my test.. Wife and me both work in Covid.. So We both are at equal high risk contact for each other.. so no Isolation at home :D

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Re: Wuhan Coronavirus Resource Thread

Postby Zynda » 23 Jul 2020 21:11

Thanks for reply Doc & to both of you for your service :)

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Re: Wuhan Coronavirus Resource Thread

Postby sudarshan » 23 Jul 2020 21:17

chola wrote:Sudarshan ji, from what I read, especially from Fauci's statements, the death rate in the US seems flat because death lags by weeks.

... It will be over 1200 on July 22. Deaths had been trending lower but is now definitely on an upward swing again.

... All this contribute to a larger lag in deaths.


Yes it did go over 1200 on July 22 :(. If the lag is that long, it's bad news for another month or two for the US.

The spike in deaths for India seems to be TN reconciling 444 previous deaths:


OK thanks, I was hoping it was something like that.

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Re: Wuhan Coronavirus Resource Thread

Postby vijayk » 23 Jul 2020 21:23

It is time for Center to set up 10000 bed hospitals in Mumbai, Pune, BLR, Chennai, Hyderabad and provide plenty of medicines

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 23 Jul 2020 21:59

DrRatnadip wrote:- As antibody tests are gettinge widely available , it is increasingly clear that number of infected is much more than official numbers.. In huge population like India it is near impossible to know exact number of infected , especially since most of infected are asymptomatic..

- Govt is yet reluctant to accept community transmission, which I believe is ongoing since long.. Long lockdown helped to slow transmission but clearly failed to stop it.. But it gave us time to prepare..

- From what I heard, situation in mumbai is improving.. Pune is nearing peak and expected to improve in next 2 wks..

- I dont see any utility in strict lockdowns now.. We must accept to live with covid.. Uncertainties due to lockdown is killing more business than lockdown itself..

- Many young general practitioners are now treating mild Covid 19 pts.. This is helping reducing load on refferal centers and reducing panic..


Thanks for your great input, Doctor saar.

I think we should be ready for larger infection numbers as the testing expands. The key is slowing the rate of infection and not worry about the total number of infections. Because of the size of the population it will be large regardless.

We need to get to a plateau and then get on a downward slope on the graph after the initial surge in testing.

It seems that the disease is sweeping through regions in turns. Is there a way to package the processes and procedures learnt in Delhi and Mumbai and apply them to say Pune when it started expanding there a week ago? Or must each region go through this in order to get a handle on things?

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 23 Jul 2020 22:06

Mollick.R wrote:Bengaluru: Sent back by three hospitals, Covid doctor loses 28-day battle to virus
Sunitha Rao R | TNN | Updated: Jul 23, 2020, 09:57 IST

BENGALURU: A 50-year-old Covid-19 warrior doctor, who had been refused admission by three private hospitals, succumbed to the virus at a hospital of Bangalore Medical College and Research Institute (BMCRI) on Thursday.
Dr Manjunath ST was on Covid-19 duty at Chikkamudavadi primary health centre in Kanakapura taluk, Ramanagara district, when he contracted the virus. He was the second member of his family to succumb to the virus; his father-in-law died two days ago.



This is tremendously, tremendously upsetting. Someone fighting on the frontline, putting themselves in harm's way cannot get help? How can this be?

I believe Delhi has a field hospital for HCW. This needs to be set up in all cities so these heros can fight and know that they have someone have their back. It is like the SAR squads in our military to let our jawans know they will not be abandoned. It must be the same for our covid warriors.

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Re: Wuhan Coronavirus Resource Thread

Postby SRoy » 23 Jul 2020 22:15

^^
Seems like a made up news.
We are good extremely well. Our mortality rate is very low.
People are getting admitted in hospitals, treated getting well.

Please don't spread doom and gloom. None is warranted.

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 23 Jul 2020 22:17

sudarshan wrote:
chola wrote:Sudarshan ji, from what I read, especially from Fauci's statements, the death rate in the US seems flat because death lags by weeks.

... It will be over 1200 on July 22. Deaths had been trending lower but is now definitely on an upward swing again.

... All this contribute to a larger lag in deaths.


Yes it did go over 1200 on July 22 :(. If the lag is that long, it's bad news for another month or two for the US.

The spike in deaths for India seems to be TN reconciling 444 previous deaths:


OK thanks, I was hoping it was something like that.


In two months, school will start along the flu season. I really don't know what will happen then. It will be very scary.

Yes, it is better that those were older deaths in TN but added worry for my parents about family in Chennai. My mother is petrified for her sister and my auntie is petrified for mom. At this point both places are scary but at least in India everyone is on the same page.

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Re: Wuhan Coronavirus Resource Thread

Postby Sidhant » 23 Jul 2020 22:57

SRoy wrote:^^
Seems like a made up news.
We are good extremely well. Our mortality rate is very low.
People are getting admitted in hospitals, treated getting well.

Please don't spread doom and gloom. None is warranted.

Saar these are not made up news. Someone in my wife’s family recently died due to heart condition coz multiple hospitals refused admission without Covid negative certificate. The person died on the road while being transported from hospital to hospital.

And that too in the National capital “New Delhi”.

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Re: Wuhan Coronavirus Resource Thread

Postby Zynda » 23 Jul 2020 23:11

vijayk wrote:It is time for Center to set up 10000 bed hospitals in Mumbai, Pune, BLR, Chennai, Hyderabad and provide plenty of medicines

I think we need AS intervention (or a high-level team which reports directly to AS/HM). Apparently, Delhi has made progress after AS's intervention.

Humanity would be living with COVID-19 virus for decades: UK medical experts tell parliament

While the world rejoiced on Monday after news that the Oxford University has reported satisfactory progress from the vaccine test results and was conducting bigger field tests in the UK, medical experts in the UK told the country's parliament that the vaccine is unlikely to eliminate the virus for good. The experts have warned that mankind will be living with coronavirus for many years to come.

Britain's health minister Matt Hancock had opined on Tuesday that under the "best-case scenario" a COVID-19 vaccine will be ready for Christmas, his declaration had brought in a huge cheer as the world is battling the worst pandemic in almost a century. Riding on the optimism of a vaccine trial that is showing encouraging results, even the UK Prime Minister Boris Johnson had said last week that he hoped things will be back to normal by Christmas.

But Professor Sir Jeremy Farrar, the Wellcome Trust director, told the UK's House of Commons' Health Committee that the belief that "things will be done by Christmas" is too far-fetched. Professor Farrar advises that a more realistic view be adopted. The BBC report cites the professor who heads a government advisory panel on coronavirus as saying, "This infection is not going away, it's now a human endemic infection... The world would be living with Covid-19 for very many, many years to come".

"Even, actually, if we have a vaccine or very good treatments, humanity will still be living with this virus for very many, many years.... decades to come." He also warned against letting down the guard disregarding safety measures such as masking-up, social distancing, testing, contact tracing, hand hygiene etc and warned of a second wave soon if complacency sets in.

'Virus now endemic, vaccine is not a forever cover'
It is not just Professor Farrar who has expressed concerns over the excessive hype over the vaccine trial reports. Professor Sir John Bell, of the University of Oxford, too, advises taking the positive news announced on Monday that trials by his university had triggered an immune response - with a pinch of salt where hopes of total elimination of the virus are concerned.

Prof Bell admitted that while the research at the University of Oxford may be an important step in developing a vaccine, he does not trust that Covid-19 would ever be eliminated despite the intensive research and global cooperation. "The reality is that this pathogen is here forever, it isn't going anywhere," he is reported to have told his nation's parliament.

"The vaccine is unlikely to have a durable effect that'll last for a very long time, so we're going to have to have a continual cycle of vaccinations, and then more disease, and more vaccinations and more disease. So I think the idea that we're going to eliminate it across the population, that's just not realistic," the report quotes Professor Bell as having said.

Comparison with the Global Polio Eradication Drive
Medical experts believe coronavirus disease has become endemic and will likely follow the trajectory of polio and/or measles that have vaccines but still continue to circulate among humans. Mankind's fight against polio has witnessed widespread vaccination, yet the disease circulates in some areas as many cases do not present easily recognizable symptoms. An infected person can remain unnoticed and continue to spread the virus to others.

In the case of measles, too, a significant period of time elapses between exposure to the virus and the development of the rash that manifests the disease's first symptoms. As a result of this lacunae, an infected patient becomes contagious before the rash appears, and can spread the virus before anyone realises that they have the disease.

According to BBC, Professor Bell told the UK MPs, "Look at how much trouble they've had in eliminating, for example, polio, that eradication programme has been going on for 15 years and they're still not there. So this is going to come and go, and we're going to get winters where we get a lot of this virus back in action."


Taking a flu shot is very common in N America. I believe it is catching up in India as well. If an annual flu shot cocktail which includes Covid strains as well is an acceptable solution (hoping that in a year's time we might be able to come up with an improved vaccine formulation which will extend the duration of anti-bodies present in our system). Or we will have some improved anti-viral medication for Covid.

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Re: Wuhan Coronavirus Resource Thread

Postby SRoy » 23 Jul 2020 23:12

Sidhant wrote:
SRoy wrote:^^
Seems like a made up news.
We are good extremely well. Our mortality rate is very low.
People are getting admitted in hospitals, treated getting well.

Please don't spread doom and gloom. None is warranted.

Saar these are not made up news. Someone in my wife’s family recently died due to heart condition coz multiple hospitals refused admission without Covid negative certificate. The person died on the road while being transported from hospital to hospital.

And that too in the National capital “New Delhi”.


Whatever you have written is hearsay, unverified anecdote.

That's a crime in BRF.

You stand the risk of your kin, clan, ethnicity, state being vilified and humiliated if you post anecdotes here.
So, desist.

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 23 Jul 2020 23:19

Sidhant wrote:
SRoy wrote:^^
Seems like a made up news.
We are good extremely well. Our mortality rate is very low.
People are getting admitted in hospitals, treated getting well.

Please don't spread doom and gloom. None is warranted.

Saar these are not made up news. Someone in my wife’s family recently died due to heart condition coz multiple hospitals refused admission without Covid negative certificate. The person died on the road while being transported from hospital to hospital.

And that too in the National capital “New Delhi”.


Initially hospitals were refusing Covid positive pts.. Now situation is reversed.. most hospitals are converted to treat covid pts.. If non covid pt is admitted in such hospital it may put already serious pt in further danger.. If relatives who are begging for admission in covid hospital later realize that non covid pt was treated in covid ward ,they may file negligence case against hospital..
Having clear positive or negative report helps to sagregate pts.. Problem is delay in getting report.. most RTPCR reports take between 24 to 48 Hrs.. During this time if pt worsens then it is most difficult to get bed..
That is why it is imprtant to make ANTIGEN tests available more easily.. Due to rapid reporting of antigen tests unnecessary harassment of pts due to lack of reports can be prevented..

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Re: Wuhan Coronavirus Resource Thread

Postby SRoy » 23 Jul 2020 23:19

Sidhant wrote:
SRoy wrote:^^
Seems like a made up news.
We are good extremely well. Our mortality rate is very low.
People are getting admitted in hospitals, treated getting well.

Please don't spread doom and gloom. None is warranted.

Saar these are not made up news. Someone in my wife’s family recently died due to heart condition coz multiple hospitals refused admission without Covid negative certificate. The person died on the road while being transported from hospital to hospital.

And that too in the National capital “New Delhi”.


Sorry, Sidhant for the sarcastic post.
I know what you said is true.
But some people insist all is well.
I don't whose or what agenda they are pushing here.

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 23 Jul 2020 23:38

vijayk wrote:It is time for Center to set up 10000 bed hospitals in Mumbai, Pune, BLR, Chennai, Hyderabad and provide plenty of medicines


It is not difficult to build 10000 bed hospital sir.. Difficulty is to get experienced doctors, nursing and support staff to run it..

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Re: Wuhan Coronavirus Resource Thread

Postby Sidhant » 23 Jul 2020 23:47

SRoy wrote:
Sidhant wrote:Saar these are not made up news. Someone in my wife’s family recently died due to heart condition coz multiple hospitals refused admission without Covid negative certificate. The person died on the road while being transported from hospital to hospital.

And that too in the National capital “New Delhi”.


Sorry, Sidhant for the sarcastic post.
I know what you said is true.
But some people insist all is well.
I don't whose or what agenda they are pushing here.

I understand and agree with you SRoyji...

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Re: Wuhan Coronavirus Resource Thread

Postby madhu » 24 Jul 2020 00:47

DrRatnadip wrote:
Having clear positive or negative report helps to sagregate pts.. Problem is delay in getting report.. most RTPCR reports take between 24 to 48 Hrs.. During this time if pt worsens then it is most difficult to get bed..


These number of hours are surprise to me. I know it s true as one of my friend waited for 2 days for test result. But i was talking to my customer in Indonesia and he says it took only 2hrs to get the result for him. How come such large difference in time?

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Re: Wuhan Coronavirus Resource Thread

Postby sum » 24 Jul 2020 06:41

vijayk wrote:It is time for Center to set up 10000 bed hospitals in Mumbai, Pune, BLR, Chennai, Hyderabad and provide plenty of medicines

This is the state of our infra preparedness:

Cost confusion delays work at India’s largest Covid care centre

Will BIEC finally open?

Theatrics, geriatrics in the covid roll call

I pity the unfortunate folks who will be dumped in places like this with zero sanitation/water/food supplies but on paper, a "10000 bed facility"

Honestly seeing the Blore experience so far, Sub-saharan infrastructure is the word which comes to mind. Pathetic is a understatement and the blatant greed and making money off misery of suffering patients by many folks is just heartbreaking
Last edited by sum on 24 Jul 2020 07:03, edited 2 times in total.

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Re: Wuhan Coronavirus Resource Thread

Postby sum » 24 Jul 2020 06:46

Sidhant wrote:
SRoy wrote:
Sorry, Sidhant for the sarcastic post.
I know what you said is true.
But some people insist all is well.
I don't whose or what agenda they are pushing here.

I understand and agree with you SRoyji...

My friend's wife having a delivery and in labour pain was made to run around for 4-5 hours between hospitals since he didn't have he certificate which wasn't given even after test was done 1 week back and no reasons provided even when desperately contacted citing the emergency. {The hospital had initially said its fine ad will take the COVID certificate later since patient from 9 months but last minute said no and stranded him)

Finally, some hospital agreed to take him in when all but given up hope. Its a true cluster%^&* out there and anyone in India right now is literally at god's mercy and nothing more


I really dont know where these India shining stories about our COVID "preparedness" is coming from

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Re: Wuhan Coronavirus Resource Thread

Postby Jarita » 24 Jul 2020 07:33

It’s not all black and white, is it.
It’s not as though pandemic preparedness in India is top notch though I am sure it will be after this. However at the same time, neither is it a complete gloom and doom scenario. Yes, because of the hard work of our Medicos, the recovery rates are decent and mortality rates are low, however those who end up getting COVID19 face the flailing and absent health infrastructure of the country. India cannot afford to build loads and loads of hospitals and permanent hospital capacity especially if there are no users for economic reasons. What India can do, is have a mechanism for scale up and scale down in a face of anomalous situations such as these. What we are grappling with is a scarcity of resources which has exacerbated the casualties. Had we had more infrastructure, it could have been significantly lower.

That said, this is a problem that a particular government cannot solve. I believe that the Indian government - state and national, did the best they could and some of the more extreme lockdowns were keeping the tottering health infrastructure in mind. Now tough trade offs have to be made between economy, livelihoods and disease. People can moan and groan about preparedness but if Countries like Italy ended up with patients on the streets and tents and ventilators being shared or prioritised by age, then what can we do in India. Countries cannot conjure up hospitals magically after decades of neglect. Now however, is a chance to build scalable infrastructure and a pandemic plan.
Also given the state right now the best course of action for a country like India would be aggressively preventing the disease at all stages - masks and Ppe , sanitization, prophylactic.
Another thing that would be controversial for those who love to ape western protocols, would be instituting an early home cure package for COVID19. Define a protocol that can be undertaken as soon as the disease is diagnosed and distribute to patient. And of course aggressive and cheap testing. We simply have to think out of the box and think different keeping in mind our constraints especially the hospitals. The focus cannot be case counts only. The focus has to be mortalities.
One more thing I have heard is that there is black market hoarding of medicines. Now this is something that one needs to crack down on.
There are things governments can do and things governments cannot do and there is no point comparing us to Taiwan or New Zealand. The only real comparison is China and we will never know the truth. It is certain that after this we will have a better pandemic response but immediately the government must think out of the box to crack down on law breakers, prevent spread without wrecking livelihoods and make treatments available in alternate settings.

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Re: Wuhan Coronavirus Resource Thread

Postby sum » 24 Jul 2020 08:46

Yes, there is no black and white..

the sad part is not about govt preparedness or medicos not doing their work but general callousness of few of the guys entrusted with a responsibility and the people making money off this misery. That is the heartbreaking part where greed of few guys leads to ffected guys being given run-around and literally battling life and death

Hoping that we use this as a lesson and improve further and more

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 24 Jul 2020 09:35

https://m.timesofindia.com/city/pune/my ... 136530.cms

Mylabs gets approval for antigen kits.. Hope its widely available soon..


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Re: Wuhan Coronavirus Resource Thread

Postby sudarshan » 24 Jul 2020 10:00

DrRatnadip wrote:https://indianexpress.com/article/opinion/columns/coronavirus-covid-sero-survey-6520579/


Thank you doc, sounds very hopeful.

From the above (added emphasis is mine):

The second conclusion that we must draw is that the virus is indeed intensely infectious. It has jumped over roadblocks, slipped through containment zones, evaded quarantine and contact tracing and managed to infect 43 lakh anonymous people, whose names have not appeared in any official record or contact lists. Most of them had mild or no symptoms. Those who had more severe symptoms and visited a clinic, entered into the official corona rosters. Whatever be the claims of our top bureaucrats, scientists and ministers, this transmission has happened right under their very noses.

Worldwide, the management of the disease has revolved around three key operations. The first is to control transmission, the second is to provide access to those who are ill, and finally, the third is to evolve the science of treatment. The worst excesses in India have been in the name of controlling transmission. In fact, common people, traders and industrialists, workers and farmers, are vexed by the current patchwork of local and regional lockdowns and a range of regulations which are purported to “break the chain of transmission”. We now know that this is futile. What is needed is a rapid response to symptomatic patients and a statistical approach to transmission, of simple rules of masks, ventilation and distance. Of better designed public spaces and markets, auto rickshaws and bus schedules, and new ways to manufacture new products. And, of course, to avoid super-spreading events.


This is what I was referring to as the "Parikshit syndrome," where one locks himself up in a tower trying to avoid the unavoidable. In the case of COVID, it seems that the much feared "transmission" isn't such a bad thing, the need is to avoid super-spreading events which lead to large viral loads, in turn leading to many more severe infections and deaths. Like many have pointed out in this thread (including me), case counts are misleading at best, meaningless at worst (as seen above, the true case count is like 40 times the official one), the need is to focus on severe disease cases, hospitalization, and death counts.

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Re: Wuhan Coronavirus Resource Thread

Postby sudarshan » 24 Jul 2020 10:17

I was thinking - as an example of the kind of disservice that the media does with its reporting style:

They seem to have fixed this notion of "60% herd immunity threshold (HIT)" firmly in the minds of a lot of people. The reality being that the HIT is a highly variable number. Why is this a disservice?

The nutters in Texas and Alabama have their own method behind their madness, unfortunately, the method is based on the above nonsensical notion. The thinking in those befuddled brains would be - "you know, if this 60% HIT is the number to reach, lacking treatments and vaccines and all, why don't we race to get to that number and be done with it?" So they have COVID parties and hop bars with reckless abandon, and they actually think they are performing a great service in bringing the epidemic to a halt.

The facts - the HIT depends, among other things, on the R0 number. This number represents the average number of contacts that a sick individual has, over the course of the sickness, with opportunity to further spread the disease. By "racing for the HIT," the following happens.

* The R0 goes up drastically, shifting the HIT far to the right (it might be as low as 10 to 20% in some cases, but if the R0 goes up, then the HIT goes up).
* The number of super-spreaders goes up (being correlated, among other things, with viral exposure and load), so even with the same R0, the HIT shifts to the right - but the R0 has also increased, so double-whammy.
* The infection momentum builds up. The end state of the epidemic or pandemic is NOT the attainment of HIT, the infection will keep going beyond the HIT value until it comes to a complete halt, depending on the momentum. Higher momentum, higher the offshoot beyond the HIT.
* On top of all this, since severe infections and deaths also correlate with exposure/ viral load, the mortality goes up.

So by indulging in risky behavior in the name of "getting to the 60% HIT and getting this epidemic over with," these nutters shift the HIT far to the right (it may be much less than 60% to begin with), they ensure that the epidemic carries on far beyond the HIT level, and they also ensure a higher fraction of severe disease incidence and death. So end result - deaths increase out of all proportion to the level of risk assumed by the population.

If the media would take the effort to educate on these actual issues, there might be a better chance of reducing the risky behavior by these groups. Instead the media parrots one "HIT number" which is treated as a hard and unchanging value, giving these risk-loving groups an excuse to carry on and put everybody at risk.

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Re: Wuhan Coronavirus Resource Thread

Postby nandakumar » 24 Jul 2020 10:29

sum wrote:
Sidhant wrote:I understand and agree with you SRoyji...

My friend's wife having a delivery and in labour pain was made to run around for 4-5 hours between hospitals since he didn't have he certificate which wasn't given even after test was done 1 week back and no reasons provided even when desperately contacted citing the emergency. {The hospital had initially said its fine ad will take the COVID certificate later since patient from 9 months but last minute said no and stranded him)

Finally, some hospital agreed to take him in when all but given up hope. Its a true cluster%^&* out there and anyone in India right now is literally at god's mercy and nothing more


I really dont know where these India shining stories about our COVID "preparedness" is coming from

I am a little surprised at this. My daughter delivered a baby in the 4th week of April. While the case load in Chennai hadn't taken off as it has in recent times, it was very much prevalent back then. What happened was that she had a gynaecologist with whom she was consulting. That doctor had a referral hospital for her patients. It was all set up in advance. Her consultation appointments were taken as e-pass. When she developed labour pain she was taken to the hospital and she delivered a baby there. Came home after two days. I don't know if the blood sample that they were taking were also used for Covid testing. But the point is that there was no confusion about which hospital because with maternity cases these things are sorted out a month or two in advance.

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Re: Wuhan Coronavirus Resource Thread

Postby vijayk » 24 Jul 2020 18:43



This 70 year old doctor says he got Corona

Used Ivermectin 12 mg and Doxycycline 100 mg cured. He says it's effective but not pushed because treatment is finalized in BD


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Re: Wuhan Coronavirus Resource Thread

Postby sudarshan » 25 Jul 2020 07:40

^ That IndianExpress article posted by doc Ratnadip is confirming some of the things I've been saying about the HIT and reduction in HIT owing to inhomogeneties (assuming that it is accurate, of course). Emphasis is again mine.

The second fact is the timing. It was about July 10 that the intensity of the epidemic started to diminish in Delhi. Hospital beds became available and the number of cases started to fall. The survey seems to indicate that since a large number of people are already immune, the virus is indeed finding fewer and fewer new people to infect. Moreover, the informal workers of Delhi who stay in dense pockets were the first to face the epidemic and are most likely to have developed this immunity. Since they form the matrix for a majority of the social and economic transactions in the city, their immunity should be an important factor in slowing the epidemic. That such heterogeneity in the population, in terms of number of daily contacts, may hasten the onset of herd immunity was recently noted in the reputed journal, Science, in their June issue. And this is what seems to be playing out in Delhi. A similar scenario is unfolding in Mumbai, Ahmedabad and other cities of India. Thus, if we continue to take care, we will now see a slow burn and the extinguishing of the virus within our major cities.


The bolded part above is what I was posting on regarding the inhomogeneity (they call it "heterogeneity" in the article, same thing)**. With the observed coefficient of variation (CV) for SARS-COVID-2, and with an observed R0 of 2.4, the HIT is in the 10 to 20% range. Densely populated urban areas seem to be playing out similarly - the disease achieves 20 to 25% penetration, and then peters out. That indicates a HIT of 15 to 20% (with an offshoot of about 5 percentage points before the end stage is reached). Delhi above shows 23% penetration. This of course assumes certain levels of mitigation strategies, without those, the HIT would shoot up, and if the population goes for extreme measures, the HIT could well go beyond 60%, with eventual disease penetration touching 90 to 95%. That would be the Alabama scenario. NYC seems somewhere in between, they allowed things to get out of hand before clamping down.

Rural areas seem to have much lower thresholds. France as a whole showed 4% infection, they're doing fine so far. Stockholm (not a rural area, but also not so densely populated) showed 7% infection.

I seriously hope the above article got it right, and that Mumbai, Ahmedabad, etc. will start seeing the "extinguishing" phase. That would augur well for the winter season also.

Below is the paper in Science that the above article talks about, dated 23 June 2020:

** A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2
Tom Britton, Frank Ball, Pieter Trapman


https://science.sciencemag.org/content/ ... ce.abc6810

Abstract
Despite various levels of preventive measures, in 2020 many countries have suffered severely from the coronavirus 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. We show that population heterogeneity can significantly impact disease-induced immunity as the proportion infected in groups with the highest contact rates is greater than in groups with low contact rates. We estimate that if R0 = 2.5 in an age-structured community with mixing rates fitted to social activity then the disease-induced herd immunity level can be around 43%, which is substantially less than the classical herd immunity level of 60% obtained through homogeneous immunization of the population. Our estimates should be interpreted as an illustration of how population heterogeneity affects herd immunity, rather than an exact value or even a best estimate.

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Re: Wuhan Coronavirus Resource Thread

Postby hanumadu » 25 Jul 2020 08:59

This of course assumes certain levels of mitigation strategies, without those, the HIT would shoot up


Isn't herd immunity supposed to stop further infection without other precautions? IMO, if still social distancing, masks and more importantly curbing of any economic activities are required to stop spreading infection, then its not herd immunity.

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Re: Wuhan Coronavirus Resource Thread

Postby sudarshan » 25 Jul 2020 10:01

hanumadu wrote:
This of course assumes certain levels of mitigation strategies, without those, the HIT would shoot up


Isn't herd immunity supposed to stop further infection without other precautions? IMO, if still social distancing, masks and more importantly curbing of any economic activities are required to stop spreading infection, then its not herd immunity.


Saar, I think you might be making the mistake of regarding this "herd immunity" as a fixed number. As a rough analogy (don't try to match all points, it's just an analogy):

If you jump off a plane, you will gain speed, until the "terminal velocity." This is the speed at which the air around you resists your fall to the same extent as your weight, so you stop gaining speed. For a human in the earth's atmosphere, this terminal velocity is around 40 to 50 m/s (50 m/s = 180 kmph ~= 110 mph). It's more than enough to splatter a human to pulp, even landing on water. But anything smaller than a field mouse can fall from any height on earth, and safely hit the ground and scramble away, because it's terminal velocity is much smaller. On the moon of course, no atmosphere, so the same animal (smaller than a field mouse) will still get pulped if it drops from a sufficient height.

But this "terminal velocity" for a human is not a hard value, if a human spreads hands and feet apart and maximizes surface area when falling, the terminal velocity will reduce (not enough to prevent pulping, though), whereas if the human adopts a "dive" position or curls up into a ball, the terminal velocity will increase. If the human carries an open umbrella (which doesn't get ripped apart) the terminal velocity will reduce further, but a parachute will reduce the terminal velocity to a few meters per second, allowing safe landing.

Now if the human wears a parachute, attains the terminal velocity of a few meters per second, and then thinks - "ok, I've got to terminal velocity, I don't need this parachute anymore" and rips it off, then the human will accelerate to the new terminal velocity (glide/ fall - 40 to 50 m/s). His/ her fall will still stop accelerating at the terminal velocity, only that value is now much higher. Of course, once the human lands safely, then the parachute can be ripped off, there's no more need for it at that point.

For the epidemic - with mitigation efforts (parachute), the HIT (analogous to terminal velocity above) could be 20%. Without those mitigation efforts (free fall), it could hit 60%. If the population adopts mitigation efforts and brings the epidemic to a stop (no more spread) at 20%, and then thinks "why do we need these mitigation efforts anymore?" (ripping off the parachute too soon) then the HIT will rise to the new value of 60%, and the epidemic will continue until it hits that value (the human will accelerate until the higher terminal velocity). So the need is to keep the mitigation efforts/ parachute going until "safely landing," which is the point where there are *no more active infections.* At that point, all mitigation efforts can be stopped (the parachute can be ripped off) and there is no more risk.

With vaccination, the strategy is to get beyond the value of the *unmitigated* HIT, so that people can continue with their normal lives. It is also possible to vaccinate for a *mitigated* HIT and then have people wear masks/ social distance etc., but they will have to do all that until there is no more risk, else the natural infection will continue (beyond the point of vaccination) until it gets to the *unmitigated* HIT.

So you could vaccinate 90% of the population and have them live normal lives. Or you could vaccinate 40%, and have them social distance and wear masks, that will also work (with the attendant inconvenience). They are both representative of "Herd Immunity," only, in one case, it is an "unmitigated" HIT, in the other, it is a HIT which needs further mitigation. By adjusting the level of mitigation, the HIT will vary over an entire spectrum from 0% (complete distancing - one guy per city level) to close to 100% (Alabama nutters).

Hope that makes sense.

EDIT: Further word on 'dem Alabama nutters. The media has fed them a steady stream of messages to the effect that "The Terminal Velocity is 50 m/s" so they work on that assumption that "let's get to that velocity as fast as possible, and then we're fine." So before jumping off that plane, they each grab a big 'ol block of lead, so they can accelerate to that terminal velocity as soon as possible. But by doing that, they've greatly increased their terminal velocity to say 100 m/s. Also there might have been some chance of surviving that 50 m/s fall (if *very* lucky, there have been instances of people landing on snow and surviving), but at 100 m/s, straddling a block of lead?? Not a chance.

So the media tells them that "The HIT is 60%" and they try to race for that by having COVID parties, that alone increases the HIT, not only that, the death rate also shoots up because of higher viral loads and greater risk taking in general. But the media doesn't bother telling them that, because the media itself hasn't bothered to educate itself - "60% HIT" is not written in stone, it can vary from much less than that to much more than that, depending on the behavior of the population.

END EDIT

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Re: Wuhan Coronavirus Resource Thread

Postby hanumadu » 25 Jul 2020 12:36

sudarshan wrote:
hanumadu wrote:
Isn't herd immunity supposed to stop further infection without other precautions? IMO, if still social distancing, masks and more importantly curbing of any economic activities are required to stop spreading infection, then its not herd immunity.


Saar, I think you might be making the mistake of regarding this "herd immunity" as a fixed number. As a rough analogy (don't try to match all points, it's just an analogy):


Except when you wear a parachute, there are no other side effects. In the case of an epidemic, the economy suffers and there will be misery in a different form. So who cares what the mitigated HIT is as long as the economy is functioning way below normal and people are suffering.

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 25 Jul 2020 14:54

@sudarshan, I like the terminal velocity analogy a lot. It made HIT a bit easier to understand. But the truth is most laymen will have a hard time understanding for them the fixed 60% simply made sense.

@hanumadu, there is a huge side affect to parachutes and that is many people die doing it. Aside from adrenalin junkies, people use it because the alternative is certain death. The masks and social distancing are far less dangerous but like the parachute they protect both people and the economy from slow horrible death. The economy can't function normally anyways when the hospitals are overwhelmed and fear abounds.

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Re: Wuhan Coronavirus Resource Thread

Postby hanumadu » 25 Jul 2020 17:15

^^^My point was that the whole concept of HIT is useless if we define it by what measures we take to avoid infeciton. I have no problem with parachutes or with social distancing or what ever measures we take to find a balance between economy and minimizing death and suffering.

What is the point of claiming we have achieved HIT if we are still going to have a -10% or -5% GDP growth rate?


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