Wuhan Coronavirus Resource Thread

[nam]

I hope ICMR is carry out some studies on it's recommendation of HCQ for medical personal. It would be a good test case to see the effect.

Given they are bound to be exposed to high viral levels and given the large numbers of medical professionals, we have a wonderful chance of gathering some good data.

[Lisa]

IndraDji,

Do you know if this is given as a tablet or a lozenge?

[IndraD]

https://www.globalresearch.ca/report-su ... us/5708056

kindly read this , I would assume tablet form

[nam]

Story on Indore hospital. It started noticing influx of respiratory patients in early March.
https://www.bbc.co.uk/news/world-asia-india-52242806

Use of HCQ is mentioned by the doctors. And they are noticing the numbers of patients coming through have dropped.

[Lisa]

IndraDji,

220mg is in tablet form but this is a gross weight and not an elemental weight. The 23 mg of Zinc Gluconate in the study I quoted is elemental. At the rate of a lozenge every 2 hours the actual weight taken would exceed the above reports total daily dose by the 3rd dose. More importantly, Zinc Gluconate has a higher bioavailability than Zinc Sulphate.

[pankajs]

https://twitter.com/sidhant/status/1248562932029386752

Sidhant Sibal @sidhant

We need 1 cr hydroxychloroquine tablets, we currently have 3.28 cr tablets: Health officials
#COVID

Plus 10 crore on order which will be filled in by end of this month. Plus the full capacity, this month and the next, is available for servicing Indian needs if required.

Yes, HCQ has disappeared from shops and that is a good thing else Jamatis and such will try to self medicate rather than report to the hospitals. Opposition is unnecessarily trying to spread panic.

[pankajs]

I have noticed people pull off the masks while speaking which is wrong Plus they will keep touching their face to pull the mask on and off which has to be avoided. Common sense people!

[pankajs]

https://twitter.com/sidhant/status/1248563747800543234

Sidhant Sibal @sidhant

India has placed orders for 49000 ventilators: Indian health officials
#COVID

[sudarshan]

I have noticed people pull off the masks while speaking which is wrong Plus they will keep touching their face to pull the mask on and off. Common sense people!

If they aren't the N95 kind, then I think people are better off without them. They give you a false sense of security, and it's very hard to remember not to adjust them. Touching cloth masks is almost as bad as touching your face. Plus they make it hard to talk, and of course eating or drinking is out of the q. Making the police enforce masks is even worse. I think somebody mentioned that people will pull them up to show the police, and then sneakily pull them off, which is like multiple infection events per police sighting. The surgical or N95 masks have to seal against your face, untrained people will not do a good job of that. And they're single use, which means, if you pull them off once, you discard and use a fresh mask. Maybe people in Japan and S. Korea have a lot of practice in all this. In India, traveling on a train during the 2009 (or was it 2011) scare, people had masks on, pulled them off to eat and drink or talk, put them back on (askew), touched faces, all that good stuff.

Ditto with gloves. They make you think you're safe. Whereas touching some surface with gloves on, and then touching your face, will do it right there. You're actually better off being bare-handed, since the virus, it seems, only survives on skin for five minutes, whereas it's like hours or days on other artificial surfaces.

[pankajs]

https://twitter.com/ANI/status/1248563860358873090

ANI @ANI

Yesterday, we conducted 16002 tests. Only 0.2% cases tested positive. On the basis of the samples collected, the infection rate is not high; Rapid diagnostics kits have also been sanctioned: Lav Agrawal, Jt Secy Ministry of Health

When only symptomatic cases and contacts were tested the positive rate was 3-4 %.

With wider testing the positive rate has fallen to about 0.2%. I hope I am reading that right and it continued to dip as the testing is expanded.

https://twitter.com/sidhant/status/1248568111449554946

Sidhant Sibal @sidhant

Request for HCQ was already existing. We analysed the request, sometimes, the demand can be very high but we need to rationalise it. All countries impact by #COVID asking for it: MEA on HCQ export.

Was expected. People put in high numbers and the supply was rationed. Normal in such scenario when everyone is scrambling.

[Bart S]

I have noticed people pull off the masks while speaking which is wrong Plus they will keep touching their face to pull the mask on and off. Common sense people!

If they aren't the N95 kind, then I think people are better off without them. They give you a false sense of security, and it's very hard to remember not to adjust them. Touching cloth masks is almost as bad as touching your face. Plus they make it hard to talk, and of course eating or drinking is out of the q. Making the police enforce masks is even worse. I think somebody mentioned that people will pull them up to show the police, and then sneakily pull them off, which is like multiple infection events per police sighting. The surgical or N95 masks have to seal against your face, untrained people will not do a good job of that. And they're single use, which means, if you pull them off once, you discard and use a fresh mask. Maybe people in Japan and S. Korea have a lot of practice in all this. In India, traveling on a train during the 2009 (or was it 2011) scare, people had masks on, pulled them off to eat and drink or talk, put them back on (askew), touched faces, all that good stuff.

Ditto with gloves. They make you think you're safe. Whereas touching some surface with gloves on, and then touching your face, will do it right there. You're actually better off being bare-handed, since the virus, it seems, only survives on skin for five minutes, whereas it's like hours or days on other artificial surfaces.

It's not about protecting people from getting infected, it is about not infecting others. Any mask is better than no mask, and it will at least reduce the viral load coming from infected people.

[pankajs]

Any ways mask has been made mandatory in Delhi, Mumbai and a few other places. Expect it to be applied to all Indian cities.

The face and mouth has to be covered when venturing outside even if by a dupatta. That is the current position in Delhi. Some people have already been arrested for not following the compulsory mask rule.

[pankajs]

https://twitter.com/sidhant/status/1248572439883173888

13 Countries given clearance in 1st list by India for HCQ
--US

Europe
--Spain
--Germany

Neighbourhood
--Nepal
--Bhutan
--Afghanistan
--Maldives
--Bangladesh

Indian ocean region
--Seychelles
--Mauritius

South America
--Dominican republic
--Brazil

West Asia
--Bahrain

Germany is the only real surprise. I did not hear them put in a request though it should have been expected. Italy, France & UK still not on the list is also a surprise. The others are mostly dependent on India for all their meds so was expected.

Expect a 2nd and a 3rd list soon.

[sudarshan]

It's not about protecting people from getting infected, it is about not infecting others. Any mask is better than no mask, and it will at least reduce the viral load coming from infected people.

That is a good point, if the wearer is already infected. If the wearer is uninfected, then the things I was talking about make infection a lot more likely than without the mask. So if a majority of the population is in an uninfected state, then the mask, combined with the above behavior, makes it a lot easier for them to be infected. The mask without the risky behavior is ideal of course, but people need to be trained for that (like in East Asia).

Unfortunately, there is no good way to tell who is infected and who is not (since so many people stay asymptomatic, at least for the first few days).

Maintaining distance, avoiding touching face/ head with unclean hands (which basically means - in public places), washing hands frequently, those are the important things. But of course, there's no quick way to train the population to do all that either.

In any case, the rule has been made, best thing now is to follow it.

Pankaj ji, the dupatta will work fine among women, good that they allow that. But now the peacefools have a good case to say - "we told you so" about their full-body female suits.

[pankajs]

https://twitter.com/sidhant/status/1248572439883173888

13 Countries given clearance in 1st list by India for HCQ
--US

Europe
--Spain
--Germany

Neighbourhood
--Nepal
--Bhutan
--Afghanistan
--Maldives
--Bangladesh

Indian ocean region
--Seychelles
--Mauritius

South America
--Dominican republic
--Brazil

West Asia
--Bahrain

Germany is the only real surprise. I did not hear them put in a request though it should have been expected. Italy, France & UK still not on the list is also a surprise. The others are mostly dependent on India for all their meds so was expected.

Expect a 2nd and a 3rd list soon.

https://twitter.com/sidhant/status/1248573383496753154

Sidhant Sibal @sidhant

India has given approval for export of 14 million tablets of Hydroxychloroquine.
#COVID

Only 14 million till date?!!

Perhaps this is for the first shipments while working on the rationing for the rest of the countries. Plus the dispatch would be driven by production/stock.

In addition, 100 million tablets are reserved for the Indian stockpile.

[pankajs]

https://twitter.com/rsrobin1/status/1248573151841095681

Ravinder Singh Robin ਰਵਿੰਦਰ ਸਿੰਘ راویندرسنگھ روبن @rsrobin1

#BREAKING : #Punjab cabinet extended curfew in Punjab up to April 30 and ordered for Strict enforcement.

#COVID

Following Odisa.

[Suresh S]

some practical stuff for people on the board and visitors . this is what I do in hosp per protocol and u should do the same.

How to wash hands- put enough soap in one hand hopefully with a no touch automatic dispenser. lather for 15 seconds minimum both hands. go between all fingers . do not forget the thumb. Than put all nails of one hand in your palm and rub . repeat with the other hand nails in the other palm. go upto the wrist both hands with soap. wash with water thoroughly . after that do not close the tap with your bare hands and recontaminate them. use a paper towel to dry your hands than use another clean dry paper towel to close the tap.use a good antibacterial liquid soap.

how to use hand sanitizer. exact same method and as I just described for soap except instead of soap u use hand sanitizer.

mask- as already mentioned N-95 masks are better than others but also not completely protective alone. while operating we use double mask. first N-95 , than goggles for eye protection followed by another surgical mask with face shield in case of blood or body fluid splash.so with people at high risk of exposure whether health care workers or others I suggest double mask first N-95 followed by another regular surgical mask. Any mask is better than none even if it is a scarf.use common sense about recontamination.

Eye protection - mask alone is not enough if someone sneezes on u or body fluid is splashed and eyes are exposed . virus can get entry through the eyes as well. Needless to say all healthcare workers should always use eye protection corona virus or not at all times when working.

Of course there are other more advanced methods of protection for health care workers with hazmat suits and specialty mask etc. but what I am describing is for regular folks outside hospital environment.

[DrRatnadip]

Sir,

* It is not included in any Covid 19 protocol in India i am aware of..Treatment is mostly supportive..

* Effectiveness of zinc in Respiratory viral infections is not conclusively proven.. There is no harm in adding it though , multivitamin / trace minerals are routinely used in India for other infectious diseases too..

* Zinc deficiency is common in India especially in vegetarians.. Diet rich in corn, rice , cereals contains phytatets.. phytates reduce absorption of zn.. deficiency of Zn is common in alcoholics..

* Direct anti viral effect of zinc is proven in experimental studies.. These are in vitro studies.. intracellular concentration required to achieve antiviral effect is very high and not possible physiologically even with high dose suppliments..

* Accumulation of metals inside cells to kill pathogens is well known in bacterial/fungal infections.. But Unproven in viral infections..

* However zinc can play supportive role..It is second most common trace element in body after iron. It is part of 10% proteins and about 2000 enzymes in body.. It plays important role in DNA and RNA synthesis.. As multiplication of immune cells to fight virus involves significant DNA /RNA synthesis , adequate supply of zn is desirable..

Zinc's use in flus and colds is an old story, over 30+ years old. We have been selling it for that long at least. The earliest reference was from Texas,

https://aac.asm.org/content/aac/25/1/20.full.pdf

Its use was mainly in the form of a lozenge of Zinc Gluconate at a 23 mg dose and NOT an ingested zinc. We ran out of zinc lozenges in one week flat and have not been able to restock for the last month. No manufacturer has any stock. Have never read any studies of ingested zinc having a correlation with reducing the replicatication rate of a virus, ie its not as such an antiviral but more as an inhibitor as the virus's ability to grow is curtailed.

P.S. If you search online you will find many more such studies

https://www.google.com/search?q=texas+z ... e&ie=UTF-8

*Zinc acts by two different mechanisms 1)direct virucidal effect and 2)Indirectly by helping in multiplcation of immune cells and release of interferon..

* Topical lozenges are expected to decrease local viral load by directly killing virus in upper respiratory mucosa.. There are studies which show symptomatic relief in common cold..

* Other example of zinc used as direct antiviral is in viral warts, where it is used as topical cream..

* However most studies are done in petri dish on artificial cell lines and use too high Zn concentrations than we are able to achieve intracellularly..

* Ingested Zn will correct Zn deficiency, which is more common and will be more useful..

* There are studies which show effectiveness of ingested zinc on HIV, HCV, HPV..

[JayS]

https://twitter.com/ANI/status/1248563860358873090

ANI @ANI

Yesterday, we conducted 16002 tests. Only 0.2% cases tested positive. On the basis of the samples collected, the infection rate is not high; Rapid diagnostics kits have also been sanctioned: Lav Agrawal, Jt Secy Ministry of Health

When only symptomatic cases and contacts were tested the positive rate was 3-4 %.

With wider testing the positive rate has fallen to about 0.2%. I hope I am reading that right and it continued to dip as the testing is expanded.

https://twitter.com/sidhant/status/1248568111449554946

Sidhant Sibal @sidhant

Request for HCQ was already existing. We analysed the request, sometimes, the demand can be very high but we need to rationalise it. All countries impact by #COVID asking for it: MEA on HCQ export.

Was expected. People put in high numbers and the supply was rationed. Normal in such scenario when everyone is scrambling.

Error there, its 2% not 0.2%. And another thing, the number of positive cases ICMR gives do not match with the number of cases daily added. Their test data also does not tally exactly. Like if you add daily test number to yesterday's total, it won't match today's total tests. From 9th to 10th the number of individuals tested went up by ~17000 while the total tests were <16000. Their report shows daily increase of 300 odd cases for last many days, while the total cases confirmed have been going up more than 700-800.

See the numbers for 9th and 10th April and see if the daily count tallies. Their own report says number of positive cases increased by more than 1000. But positive cases count increased by only 433..?? Even if we assume their daily number not a 24hr number but from 12:00AM to 9:00PM on each day, then also inconsistencies remain.

UPDATE - 10 April 9:00 PM

Total Tests = 161330
Total Individuals = 147034
Total +ve = 6872

Daily count
Tests = 15663
+ve = 433

UPDATE - 9 April 9:00 PM

Total Tests = 144910
Total Individuals = 130792
Total +ve = 5705

Daily count
Tests = 16002
+ve = 320

[ranneel]

https://twitter.com/ANI/status/1248563860358873090

ANI @ANI

Yesterday, we conducted 16002 tests. Only 0.2% cases tested positive. On the basis of the samples collected, the infection rate is not high; Rapid diagnostics kits have also been sanctioned: Lav Agrawal, Jt Secy Ministry of Health

That figure should be 2% and not 0.2%.

[Manish_P]

Heartening to see. And, as is their creed, our ex-services folk are offering to get back on the front-lines.

15,500 applications in less than 72 hours

Doctors, nurses, pharmacists, lab technicians, even teachers and information technology professionals send in their Bio-datas.

Chief Minister Uddhav Thackeray’s appeal asking retired professionals – especially health workers to return to work and join the state’s crisis containment effort has met with an astonishing response. Within 72 hours of the CM’s appeal, the state government has received 15,500 applications from doctors, nurses, lab technicians and teachers.

The Covidyoddhas – as the state government has branded the volunteer effort – will be assigned tasks matching their domain knowledge across the state after necessary training.

Commander Angsuman Ojha, 50, co-founder and director Indian Ex-Defense Employees Chamber of Commerce and Industry has applied on the behalf of his association. “We all are ex-servicemen. I was with the Indian Navy for 23 years. I have handled disasters and I want to help the government. We are 15 lakh ex-servicemen in Maharashtra and we would like to offer our skills in this difficult time

The response has been in line with how people have quit jobs to join the volunteer effort internationally.

To fight coronavirus, the UK recently asked for some volunteers. It got an army, as more than 750,000 people pitched in to help older and more vulnerable Britons. They carry bags of groceries, medicines and every other possible help from local supermarket and deliver them to the ailing and elderly marooned inside homes.

[vimal]

^^ Finally some real work being done instead of peddling fake tweets via bollywodiayapas.

[rsingh]

I wish GOI prints special wrappings for medicines sent to different countries. Putting Indian tricolour ( on packets ) is a good idea.

[rsingh]

https://twitter.com/sidhant/status/1248572439883173888

13 Countries given clearance in 1st list by India for HCQ
--US

Europe
--Spain
--Germany

Neighbourhood
--Nepal
--Bhutan
--Afghanistan
--Maldives
--Bangladesh

Indian ocean region
--Seychelles
--Mauritius

South America
--Dominican republic
--Brazil

West Asia
--Bahrain

Germany is the only real surprise. I did not hear them put in a request though it should have been expected. Italy, France & UK still not on the list is also a surprise. The others are mostly dependent on India for all their meds so was expected.

Expect a 2nd and a 3rd list soon.

It seems we have some special deal with Germany. Ventilators or testing kits deal etc

[pankajs]

^^
Same thought occurred to me much after I posted that .. we seem to be getting some Covid related equipment from them. So they jumped higher on the que higher than otherwise data would suggest.

[nvishal]

Maharashtra seems to have acquired the wilder strain of the covid19. Many of the travellers who came through the Mumbai airport were sent home after a simple thermal check. Much of the damage was already done well before the lockdown. The failed contact tracing program of the maha govt added to the problem.

There are two major clusters in Maharashtra. One is Mumbai district. The adjacent thane/raigad districts have become casualty as well because they are part of the mumbai economic block(or "greater mumbai" as the municipalities like to call it). Thane and raigad output some agricultural produce but all these three districts(mum, thane, raigad) are dependent on rural Maharashtra for supplies.

The other cluster is in pune where the local municipality has managed it better than Mumbai municipality.

Trucks constantly bring agricultural produce to these two cluster zones. The people engaged in these non-skilled jobs are very sloppy and that creates a possibility of spread to rural Maharashtra.

Another low key activity going on in Mumbai is families fleeing to their native villages in rural Maharashtra on motor bikes, carefully navigating through the locked intersections between 3-5am because the police have sleepy eyes at this point.

[pankajs]

HCQ approval for export details ..

https://twitter.com/ANI/status/1248652303164309505

ANI @ANI

India has cleared first list of 13 countries for Hydroxychloroquine. USA had asked for 48 lakh tablets of HCQ, India has sanctioned 35.82 lakh tablets. India has also sent 9MT API to US, as per their request: Sources

Brazil and Canada that are expected to get 50 lakh tablets of Hydroxychloroquine in the second consignment. In the first consignment, Brazil will receive 0.53 MT API: Sources

Bangladesh will get 20 lakh tablets of Hydroxychloroquine, Nepal 10 lakh, Bhutan 2 lakh, Sri Lanka 10 lakh (not in first consignment), Afghanistan 5 lakh, and Maldives 2 lakh: Sources

Germany will also get 50 lakh tablets of Hydroxychloroquine (in second consignment); in first consignment they are only receiving 1.5 MT API: Sources

Some countries are getting their second consignment. Seems that even during the export ban some countries had their orders filled e.g. Germany .. again looks like a quid pro quo.

As usual, some folks are unable to digest Modi getting positive limelight during this crisis
https://twitter.com/MohammadZshn/status ... 9810688000

Mohammad Zeeshan Ismail @MohammadZshn

This was not by request this was by order.."Retaliation" I hope you know the meaning.

Afsar Ali @AfsarBoji

Request ya dhamki, khul ke bolo Sir.

Ambreena Syed @Ambreen62986028

Not request that's threat

I don't know what order or retaliation or vengeance was promised by Brazil, Canada, Germany, Sri Lanka, Bangladesh, Bhutan, etc for GOI/Modi to promptly assure supplies.

Kahin deep jale kahin dil ..

[rsingh]

Is it true that Baki's do produce HCQ ? In one of talk show they boosted that they have blocked the exportation of HCQ.

[nvishal]

Is it true that Baki's do produce HCQ ? In one of talk show they boosted that they have blocked the exportation of HCQ.

Yes the paks produce it. It is produced as per local(malaria) demand. Covid19 has kicked it up.

The malaria/tropical belt

[syam]

if someone has bio weapon and want to cripple our country, the present situation in mumbai is what they would have wished for. favorable local government and what not. i am surprised they didn't hold the markaj in mumbai itself. it would have been 'great' with infection spreading in earlier days itself. they even smuggled some illegal mullahs from outside.

[Karan M]

Pankajs, these are all ISPR trolls. They all have the same script on every topic and are in complete denial. Meanwhile in Pak, doctors are getting beaten up for protesting that they dont have PPE by Army/cops.

[pankajs]

^^
True .. but many peacefuls/Sikculars of India too have this basic urge to deny Modi/India any credit.

Mean-e-while ... Bakistan has capability for everything that India does and then some more. Brazil too produced HCQ but imports the API from India for that.

[pankajs]

https://www.deccanherald.com/city/top-b ... 23604.html
Coronavirus: Two wards of Bengaluru sealed completely to contain COVID-19 spread

Scaling up efforts to contain the community spread of COVID-19 in Bengaluru and other parts of Karnataka, the government has decided to order a clampdown in COVID-19 hotspot areas and geographically seal off the regions from the rest of the state. The Bruhat Bengaluru Mahanagara Palike (BBMP) has imposed a clampdown in two wards — Bapuji Nagar and Padarayanapura off Mysuru Road in the Chamarajpet limits with immediate effect. The officials have completely sealed the two wards and banned the entry into and exit of people from the wards.

Giving details of the procedure, B H Anil Kumar, Commissioner of BBMP told media personnel that both the wards would be sealed for any movement of either people or things. “There will only be one point of entry and exit. All those (police, health workers, BBMP, Civil Defense) who will interact with the ward people will be screened and documented. We will provide all essential things at the doorstep. For 14 days, no one shall come out from the areas,” the Commissioner said. Sources in the BBMP revealed to DH that the decision to seal the areas was taken after three people tested positive for COVID-19 and keeping in mind the density of population in the region.

1. Bapuji Nagar and Padarayanapura off Mysuru Road in the Chamarajpet sealed in Bangalore

2. Completely banned the entry into and exit of people from the wards.

3. There will only be one point of entry and exit.

4. All those (police, health workers, BBMP, Civil Defense) who will interact with the ward people will be screened and documented.

5. We will provide all essential things at the doorstep.

6. For 14 days, no one shall come out from the areas

This is how a complete sealing will be enforced.

<< CT >> Does anyone spot an opportunity here? Think what it would mean if this model could be replicated across India in trouble spots. NO more on this from me. << /CT >>

[Manish_P]

if someone has bio weapon and want to cripple our country, the present situation in mumbai is what they would have wished for. favorable local government and what not. i am surprised they didn't hold the markaj in mumbai itself. it would have been 'great' with infection spreading in earlier days itself. they even smuggled some illegal mullahs from outside.

They tried... and nearly succeeded

When Maharashtra Police cancelled a parallel, bigger Tablighi Jamaat event to avoid Covid-19 spread

Even as the government continues to gauge the impact of the huge gathering at Nizamuddin Markaz that has risked thousands of lives, sources say the Tablighi Jamaat had planned for an even bigger event in Vasai, Mumbai on March 14.

The Tablighi Jamaat was supposed to be attended by thousands of devotees including a large number of foreign delegates.

According to police, permissions for the event had been sought in January and Palghar Police had even granted permission. The Inspector General of Police, Konkan Range, Niket Kaushik called for a meeting with Superintendent of Police, Palghar district, Gaurav Singh and discussed details of the event and number of people expected to attend. Upon learning that the event was to be attended by thousands of people and also foreign nationals amid the coronavirus pandemic, the decision was taken to withdraw permission and the event was cancelled.

[madhu]

1. Bapuji Nagar and Padarayanapura off Mysuru Road in the Chamarajpet sealed in Bangalore

I stayed inbetween these two area 5yrs back for almost 15yrs. These area are minority dominated area. Other area in blore is shivaji nagar. Need to see what they will do there.

[IndraD]

[IndraD]

[pankajs]

For the record, the total HCQ approval based on the first list

https://twitter.com/ANI/status/1248654354984259585

ANI @ANI

India has cleared first list of 13 countries for Hydroxychloroquine: USA, Spain, Germany, Bahrain, Brazil, Nepal, Bhutan, Afghanistan, Maldives, Bangladesh, Seychelles, Mauritius & Dominican Republic - total 14 million tablets, API 13.5 MT ton: Sources

13.5 MT API = 13.5 x 5 Million = 67.5 Million tablets of 200 mg each

Therefore, India has effectively approved exports of = 81.5 million tablets of 200 mg each (Standard dosage it seems).

Added later:

1. US got most of its supplies as API (9 MT = 45 million tablets of 200 mg each)
2. Looks like API production ramp up is on track for GOI to sanction such a quantity in the first list.

[Gerard]

India to ship hydroxychloroquine tablets to 13 countries in first consignment

UK expects first batch of 3 million paracetamol packets from India soon

[IndraD]

Paper yet to be published in NEJM about a clinical trial shows HCQ when given after severe Covid19 has set in worsens outcome.

Hydroxychloroquine administration to the hospitalized SARS-CoV-2 positive population was
associated with an increased need for escalation of respiratory support. There were no benefits of
hydroxychloroquine on mortality, lymphopenia, or neutrophil-to-lymphocyte ratio improvement.