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.
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.
Simples, yes ?
yikes !!!
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.
That bolded bit come as news to me.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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