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Thread: Will SARS make a come back?

  1. #106
    Turbanator Senior Contributor Double Edge's Avatar
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    Interview with the former head KK Aggarwal of the Indian Medical Association on coronavirus. He comes across better in audio than the way the caravan magazine portrayed him. Wish IE had a transcript of this conversation as its very good.

    Q. Avoiding bacteria & viruses is pretty hard to do in day to day life. We touch a lot of things. So what can be done ?

    A. Hand washing is incomplete without disinfection. If a surface is dirty a hand sanitiser doesn't help. The surface needs to be cleaned first & disinfected. Only then is the hand wash effective. If my table is dirty, every time i touch it then i would have to wash my hands. Better to wash the table with 0.1% bleaching solution. If you clean the surfaces you use with such a solution then you do not have to repeatedly wash your hands when you touch them. Chair arm rests, door knobs, tables, cupboard handles should be decontaminated three times a day.

    Use tissue paper when touching nose, eyes & mouth .

    These precautions are more effective than wasting money on a hand sanitiser. A simple hand wash is as good and probably better as it takes away dirt as well. A hand sanitiser cannot take away dirt.
    Another point i learnt is alcohol & soap both damage the envelope of the corona virus making it more vulnerable. Alcohol of 70% is broad spectrum enough to kill it, washing removes it.

    Q. What sort of symptoms should people be looking out for ?

    A. Only one symptom. Do not ignore fever with cough.

    If you have just a cough, its pollution.

    If you have a cough & cold, its allergy.

    If you have a cough, cold & fever, its flu.

    If you have a fever & a sore throat, its a bacterial infection.

    If you have cough, fever & breathlessness, its corona like illness

    These are standard guidelines.

    No fever means no corona. Fever is a must to be considered as corona.
    Simples, yes ?

    Q. The mean age of people dying is 81, does it mean young people are safe from this virus.

    A. Forget corona. The people at risk of pneumonia are 65+. People at that age have a compromised lung & immune system and should be isolated. These people cannot tolerate any pneumonia. A patient with pneumonia that develops SARS is 85% at risk any way without corona.

    Children can also contract pneumonia but since their lung fitness is good they can tolerate pneumonia. The case fatality rate of children under the age of 10 is zero for corona infections and up to 40 years is 2 per 1000. Because people in this age group can tolerate low oxygen capacity for up to two weeks. If your lungs can tolerate a pneumonia for 4 to 6 weeks everybody will recover. They elderly do not have this reserve.
    Q. What measures can old people take to be safe ?

    A. 1) put up a board outside the house that says if you have a cough, cold & fever, do not enter !

    2) They should not go to the hospital, only tele consultation.

    3) Avoid meeting people in crowds. Mass gathering is more than 1,000. A gathering is 4 - 1000. Definition of crowd size comes from the police. Avoid any gathering larger than 4 people.

    4) Avoid unknown people who do not declare their health status. Goes on to mention the Hinduja hospital debacle. One patient shows up for a heart problem. Turns out he's corona positive and 96 people at the hospital including the doctor who treated him had to be quarantined. Bad SOP at the hospital. They did not have a sign warning people who have a fever & cough NOT to come in the main entrance but the side. Particularly if such people have previously visited a place that is corona affected.
    Q, Do we know how the body behaves after the virus, is there any long term damage and does the body develop immunity ?

    A.Only RNA testing is available which is a throat swab. We don't have antigen testing as yet. No IgG/IgM which is the rapid test.

    Given the virus is only 3 months old. We don't know as yet its effect on the body 6 months later. Whether antibodies are still present after that time. The experience with Zika & Ebola is the virus can persist in the testes and appears in the semen. Time will tell whether the disease will re-appear or become chronic. We don't know.
    yikes !!!

    Q. Numbers in India are low, is this because we have not tested enough people or the virus just has not spread very far ?

    A. At the start of this interview we have just over a 100 cases with 2 deaths. The doubling time of this virus is 7.1 days so we expect to see cases double each week. By next week it should be 200. If our total number of cases does not exceed a thousand it means we have won the battle.

    China has 50 per million population
    Italy has 250 per million population. Total population of Italy is 60 million. If 250 per million is infected there then it is very, very high.
    USA has 4 per million population
    NZ has 10 per million population
    India has 0.1 per million population

    At the moment we have it under control but mistakes have been made which should not have happened eg. Hinduja hospital. In Delhi, one patient was referred to a govt hospital by a private one and its unknown what precautions the private hospital took before sending him over. Then in Karnataka a patient died, was shifted to another hospital and back again to the first. If these mistakes happen again we will lose the game. Otherwise, clearly we are under control. 0.1 per million population is the best we can expect.
    Famous last words, i hope not. He does not answer about not tested enough. That comes in his next two replies.

    The case in Karnataka was of a muslim preacher. This means he has an anxious flock watching over him in numbers sufficient to get away with this type of doctor & hospital shopping.

    Preachers like this from any community will mix with people and be very efficient at spreading the disease. Who know how many that preacher who died in Karnataka ended up infecting.

    Q. Indian health officials frequently say there is no community transmission in India. Can you explain further what that means ?

    A. Three C's. Case, Cluster & Community

    First case entered India which resulted today in 100 patients in clusters around the country. 30 in Maharashtra is a cluster.

    How do we look for community spread ?

    - In Bombay every 20th H1N1 acute respiratory illness case is checked for COVID-19. All were found to be negative. This is one way to test for community spread.

    - The next indicator of community spread is if the doubling time shortens to one or two days from seven. In Korea the doubling time reduced to a day. Same happened in Italy & Iran. Getting 700 - 800 cases a day is community transmission.

    If the doubling time remains seven days it implies there is no community transmission.

    If in India today we have a 100 cases and the day after another 100 show up. We're not seeing this in India as of yet.

    - The DG of ICMR has said it is inevitable that community transmission has to occur in India. So either its already occurring which we're unable to detect. Reason being, our current policy is, if i'm positive i will be tested twice, now and after treatment and all my contacts will be kept under observation and testing them only if they're symptomatic. So we're not using all our resources to check all the contacts so maybe we might be missing a number of cases in the community. If this was true then the number of cases we've found so far should have been higher by now. At least 300 and not 100. The people we're missing likely are mild cases because we're only testing people with symptoms.
    That bolded bit come as news to me.

    Q. What kind of burden is this putting on our health care system and do we need to involve the private sector in testing as well ?


    A. 80% of people will go to private sector hospitals. Nobody goes to the govt sector hospital directly, they will be referred there via a private sector hospital. If we do not take the private sector on board we will fail. Once a national disaster has been declared every doctor in the country must be taken on board by the govt and directed to follow the protocols established.
    So he is supportive of taking the private sector on board. In his last interview which i posted excerpts from caravan magazine he said they were not allowing more tests because they wanted to keep a handle on panic. More affected people makes people nervous. More affected people are found with more testing. It seems we are missing asymptomatic people who are effective spreaders.

    The private sector might be getting readied in the background already for when community spread begins which i think will happen with time. Since its been declared as 'inevitable'.

    Please note that Trump has already declared that NOTHING is 'inevitable' : D
    Last edited by Double Edge; 18 Mar 20, at 02:19.

  2. #107
    Turbanator Senior Contributor Double Edge's Avatar
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    More myth busting


  3. #108
    Senior Contributor Oracle's Avatar
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  4. #109
    Turbanator Senior Contributor Double Edge's Avatar
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    Quote Originally Posted by Oracle View Post
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    Wonder if the Sindh Spike is due to the Afghans in Karachi. Could just be unlucky with super spreaders.

    Ghani made it clear he could not close the border with Iran.

    Paks have closed their borders with both western neighbours.

  5. #110
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    We're now at 8,198 official cases in Germany that have been properly electronically reported to national registration. 1,609 in my state, 2 in my city.

    Except the state social ministry reports 2,184 for the state. And the municipal health agency reports 47 for my city, five of which are staff at the local university clinic. Result of delays in reporting it upwards. Now scale up...

    For a measure of where we're at:
    • Since wednesday 1 pm the municipal police agency are doing "friendly visits" to shops and restaurants to "advise" them on the current rules for operation. In four-man teams with body armor, batons and pepper spray equipped, along with two a bit better-armed state police officers for escort. Currently all shops not serving system-critical functions (food and medical distribution pretty much) are required to close, for gastronomy only places providing actual meals for take-away are allowed to stay open - provided they make sure the people waiting in line (outside only of course) stand 1.5m apart. And yes, there's places that now have markings for that on the ground.
    • The city has begun restructuring infrastructure services to focus on core functionalities. For example the public garbage collection service is cancelling all operations that aren't part of the core functionality of retrieving trash - no retrieval of bulk waste, no places where you can hand in hazardous waste or similar, no street cleaning, no public toilets. They're still pulling the trashcans to the street themselves, but the city is already "asking" that people support the service by doing that.
    • Burial ceremonies at cemetaries are limited to maximum ten people within a "closest circle of family and friends" attending. Weddings at the civil registry are limited to the bridal couple plus maximum two witnesses and exactly one other guest. The civil registry is otherwise closed to the public except for the purpose of formally registering deaths.
    • We have a new word called "system critical". If both parents are in a system-critical profession (police and firefighters, medical, public infrastructure, food and pharma production and distribution plus ... undertakers) then they still get emergency childcare in order to remain fully available for their job. At least if the kid is under 12. Emergency childcare is organized such as to minimize infection risk (... so the system-critical parents can continue work): small groups (typically less than 5 kids) physically separated, kids suspected of infection are kicked off, any kids outside the programme are (literally) outlawed from entering the premises - their previous schools and kindergartens.
    • The only education facilities not ordered closed are vocational schools training medical and care staff, and only for those students who either will finish their training by end of May this year or are doing a course to qualify them as intensive-care specialist nurses. Specialized schools integrated with homes for disabled and abandoned children may also continue to operate.
    • The Red Cross has begun initial stages of mobilizing its 60,000 volunteers in the state (formal stage: 2nd wave - out of four possible), using their ready units to provide staff relief to hospitals, support for quarantined people and running drive-through testing stations. There's an effort underway to double the number of intensive-care beds in hospitals (to 6,500 in the state) and (as preparation for moving mobilization to 3rd wave) to convert hotels, rehab clinics and similar places into treatment centers for less serious cases. The guy in charge of the Robert Koch Institute, the federal agency in charge of handling the numbers and advising the government on the crisis, predicts a worst-case scenario of 10 million in-clinic patients in the next 2-3 months.
    • Locally, in this city a new hospital wing under construction and originally planned for handover in two weeks with about 320 beds will probably now fully be redesignated for corona patients temporarily - they already put in a corona station using about one-eigth of the building. A certain local chemical company got a permit to cut a couple tons of isopropanol from an inbetween step in their regular production of other chemicals in order to provide it (for free) to hospitals in the area.
    • On-demand scheduled public transit - run by taxi companies with cars, not busses - will cease operations tomorrow evening; this affects about 280 routes in the wider area. The 1,000 busses in operation in the area have their front section blocked off to protect the drivers from infection, the 200 trams now hail at every stop and open doors automatically so that people don't have to push buttons. My 8:30 am commuter rail train yesterday had about 5% of its seats filled instead of the usual 70+%.


    For illustration of the first bullet point:

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    Last edited by kato; 19 Mar 20, at 01:53.

  6. #111
    Senior Contributor Oracle's Avatar
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    Politicians are elected to serve...far too many don't see it that way - Albany Rifles! || Loyalty to country always. Loyalty to government, when it deserves it - Mark Twain! || I am a far left millennial!

  7. #112
    Turbanator Senior Contributor Double Edge's Avatar
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    ^Nobody's betting on the vanish as quickly as it arrived bit

  8. #113
    Senior Contributor Oracle's Avatar
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    Quote Originally Posted by Double Edge View Post
    ^Nobody's betting on the vanish as quickly as it arrived bit
    Lol, yeah.
    Politicians are elected to serve...far too many don't see it that way - Albany Rifles! || Loyalty to country always. Loyalty to government, when it deserves it - Mark Twain! || I am a far left millennial!

  9. #114
    Senior Contributor Oracle's Avatar
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    The Army puppet is begging again. He wants a debt write off. Don't talk about India, you twat. Compare Pakistan with Somalia.
    Politicians are elected to serve...far too many don't see it that way - Albany Rifles! || Loyalty to country always. Loyalty to government, when it deserves it - Mark Twain! || I am a far left millennial!

  10. #115
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    They've lowered the cap on allowed gatherings and aggregations on public grounds to maximum five people in this city, plus mandating a minimum 1.5m distance between people in smaller groups (and yes, this means no more cuddling in public for couples). Use of force is threatened to enforce this.

    Reason for this is that yesterday they planted several dozen signs around a municipal park downtown where groups of youths hang out due to the warm weather. The signs were ignored. So they're basically implementing the necessary legal framework to pull batons on them.

  11. #116
    Turbanator Senior Contributor Double Edge's Avatar
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    ^Sounds a lot like Sec.144 in India.

    Prohibits gathering of 4 or more people. This is usually invoked in times of civil unrest.

    Break the rule and you're getting hauled in.

  12. #117
    Senior Contributor Oracle's Avatar
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    How are COVID-19 cases rising so rapidly in Pak? I can understand cases piling up in Balochistan because of Chinese presence, but Sindh?

    Okay, got it. Pilgrims who returned from Iran earlier.

    671 returnees from Iran leave for Sindh in convoy of 18 buses

    Squalid Taftan quarantine camps present a sorry state of affairs

    If +ve cases are above 450, how come reported deaths are so low?
    Last edited by Oracle; 20 Mar 20, at 02:32.
    Politicians are elected to serve...far too many don't see it that way - Albany Rifles! || Loyalty to country always. Loyalty to government, when it deserves it - Mark Twain! || I am a far left millennial!

  13. #118
    Turbanator Senior Contributor Double Edge's Avatar
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    Quote Originally Posted by Oracle View Post
    If +ve cases are above 450, how come reported deaths are so low?
    People infected are younger and can recover on their own.

    Germany was similar, got to almost a 1000 before they saw deaths.

    They've kept that ratio as well, presently at 8,198 cases and 13 deaths

    We've ordered a million test kits from Germany btw.

    Quote Originally Posted by Oracle View Post
    Okay, got it. Pilgrims who returned from Iran earlier.
    We're due for around 1,200 from Iran soon

    India to send C-17 Globemaster to airlift Indians from Iran | ET | Mar 10 2020

    India is in touch with Iran on possible evacuation of Indian pilgrims and students stuck in the coronavirus-hit nation, Health Minister Harsh Vardhan had said in the Parliament last Thursday. An estimated 1,200 Indians, mostly students and pilgrims, are in Iran currently.
    Number of Kashmiris in that lot.

    Covid Red: Indian cases 1.7 times more in Iran | ET | Mar 18 2020

    Almost twice as many infected Indians in Iran than in entire India (!)

    These lot are going to be watched very closely
    Last edited by Double Edge; 20 Mar 20, at 03:10.

  14. #119
    Turbanator Senior Contributor Double Edge's Avatar
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    That's what the disease & surveillance guys stamp you with : )

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    If that's the same permanent ink they use when we vote then its not coming off for a few months.

  15. #120
    Turbanator Senior Contributor Double Edge's Avatar
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    Quote Originally Posted by Ironduke View Post
    I don't know what to make of this "herd immunity" thing, but perhaps eventually the best people to work among at-risk populations are those who've contracted the disease and recovered. Provided one can't be infected with it twice, once being enough for immunity.
    It's dawning on me that many developing countries are going to have no choice but to go with this "herd immunity" thing : (

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