[Lobogris]

Originally Posted by joslicx

And the worst part is, even if one person is left with the virus the whole chain can start again and again! Can it really and realistically be guaranteed that it wont happen??

If we have 10,000 people infected then they can infect another 30,000 and so on. If on the other hand we reduce the number of infected to say 1,000 then they would infect around 3,000 which is a lot better. That is the idea behind the lockdown. I don't think it fully works as a lot of exemptions have to be made, a lot of people don't follow it, a lot are unaware of social distancing concept, a lot need to make a living and finally a lot have to live in cramped conditions. So a lockdown in India is probably around 30% effective. Nevertheless it would help to some extent but ultimately the virus would probably run its course.

[dailydriver]

Centre announces a three tiered structure for treating Covid-19 cases

The Union Health & Family Welfare Ministry Tuesday released new guidelines to treat coronavirus cases in facilities other than hospitals, an attempt to use resources “judiciously” as India’s case total went past 4,000.... there will now be a three-tier system to treat patients, depending on the severity of symptoms.

Under the system, only severe cases will be admitted in “Dedicated Covid Hospitals”, which would have fully-equipped ICUs, ventilators, and beds with oxygen support. The patients assigned as moderate cases will be treated in “Covid Health Centres”, which would be full hospitals or a separate block within the premises with its own exit/entry and assured oxygen support.

The cases diagnosed as mild, meanwhile, will be treated at “Covid Care Centres” to be set up in select hostels, hotels, stadiums and lodges, government-owned as well as private.

Source

The lockdown has given us the much needed time to put necessary structures in place, although the sheer number of cases that could emerge once normalcy is restored, could overwhelm the best of the systems.

One Covid-19 patient can potentially infect 406 others in a month in the absence of lockdown, whereas his ability is reduced to just 2.5 infections under lockdown restrictions, says an ICMR study.

Given that it would be far fetched to imagine a complete corona - free country by the end of the lockdown, the chances of a single carrier spreading it to multiple persons very much remain. So, the more we prepare now, the better for the future.

[carboy]

Originally Posted by Lobogris

If we have 10,000 people infected then they can infect another 30,000 and so on. If on the other hand we reduce the number of infected to say 1,000 then they would infect around 3,000 which is a lot better. That is the idea behind the lockdown.

Yeah, but the 3000 would infect 9000 more & we are back to square 1. All we have bought is time. The solution is either a vaccine or 60% of population already infected so that there is herd immunity.

Lockdown will not change final total number of people infected significantly. All it will do is slow down the time by which we reach that final number.

[yd_gli]

On a separate note, I've been watching the American news channel Fox news for a few days now. Almost every State governor that they intervew is very clear on the projected date for the peak number of cases in his State at an error of +/- 1 day. I have not seen any such data or projections for Indian States and the country as a whole. Does anybody have an idea why?

[hserus]

Originally Posted by yd_gli

On a separate note, I've been watching the American news channel Fox news for a few days now. Almost every State governor that they intervew is very clear on the projected date for the peak number of cases in his State at an error of +/- 1 day. I have not seen any such data or projections for Indian States and the country as a whole. Does anybody have an idea why?

They would need astrology. And those figures are meaningless without interpreting the data gathering behind them.

Read https://fivethirtyeight.com/features...e-meaningless/

[vivek95]

Originally Posted by carboy

Yeah, but the 3000 would infect 9000 more & we are back to square 1. All we have bought is time. The solution is either a vaccine or 60% of population already infected so that there is herd immunity.

Lockdown will not change final total number of people infected significantly. All it will do is slow down the time by which we reach that final number.

Sorry but the virus does not work like simple mathematics. Its not 1000 is to 3000 and that is to 9000. The transmission process is very complex. Counteraction by the human immunity is another whole different level of complexity. So, lot of factors play a role and we are dealing with something that is not visible to the naked eye.

Lockdown ensures minimal interaction between people. If as many positive patients are contained and isolated as early as possible, the spread indeed halts at some point. That is the aim of lockdown apart from reducing the burden on healthcare by buying time. Ofcourse, this entire exercise is incomplete without large scale testing. Herd immunity is poorly understood with this novel virus and hence lockdown is the only feasible option available to the mankind at present until there is a specific vaccine or antiviral that can fight this out.


-Dr. Vivek

[joslicx]

Originally Posted by vivek95

Lockdown ensures minimal interaction between people. If as many positive patients are contained and isolated as early as possible, the spread indeed halts at some point. That is the aim of lockdown apart from reducing the burden on healthcare by buying time. Ofcourse, this entire exercise is incomplete without large scale testing. Herd immunity is poorly understood with this novel virus and hence lockdown is the only feasible option available to the mankind at present until there is a specific vaccine or antiviral that can fight this out.


-Dr. Vivek

I think we are discussing not the reasons for having lockdown or efficacy of it, but the post lockdown scenario and how to come out of it. Nobody would dispute at the moment if it was the best thing to do, especially since it cannot be undone and also India is largely unscathed and probably lockdown has had some role in it.

But the point still remains that at some point we will have to come out and work. That would happen much much before there is a vaccine for the virus in the market. Somebody has to produce all the medicines, your medical gear, your necessary items so all those people have to work. But the way mostly we are setup, there are supply chains, no one company makes everything, so the suppliers of these companies also have to work and their suppliers have to work. All of them use computers and machines and they need parts and all so they all have to work. Then moment of goods is needed so transportation has to work which means at some point their consumables also have to work (else your truck might be stuck as it is punctured!) and so and so on... So at some point a lot of people have to come back to work else everything will just stall! Even for just your basic hospitals to work a lot of people will have to come out and work!

[vivek95]

Originally Posted by joslicx

I think we are discussing not the reasons for having lockdown or efficacy of it, but the post lockdown scenario and how to come out of it. Nobody would dispute at the moment if it was the best thing to do, especially since it cannot be undone and also India is largely unscathed and probably lockdown has had some role in it.

Okay, my bad, I misinterpreted I have briefly lost the connection with this thread. Thanks for your perspective on post-lockdown scenario. Intended to highlight that the transmission process is not mathematical. If that was true, every contact individual of a positive patient would have in turn become positive and so on. But that is not the case as some close contacts do test negative as well.

[mvadg]

New research examines wastewater to detect community spread of Covid-19

A series of crucial setbacks in Covid-19 testing has made it difficult to keep up with the virus’ rapid spread, and has inspired some researchers to look to wastewater to help fill in the gap of measuring how prevalent SARS-CoV-2 is in a given community

Sewage is already tested in many countries for clues to a number of health issues, including the prevalence of narcotics, but I have no idea how applicable this is to India, given the state of our infrastructure for sewage treatment.

[ckranjan]

Fun read of the Morning.
https://www.theguardian.com/world/20...rld-domination

Chinese regime is the best sniffer of Racism.

[m8002?]

This is getting even more crazy.
https://www.thehindubusinessline.com...le31270033.ece

China sold the PPEs it got as a donation from Italy to Italy: Report

If true, its a real despicable act.I guess more and more governments will start ganging up on the Chinese.

[V.Narayan]

Originally Posted by hserus

They would need astrology. And those figures are meaningless without interpreting the data gathering behind them.

Read https://fivethirtyeight.com/features...e-meaningless/

Thank you for sharing this article. It is a long read but explains the whole relationship of detection, testing, actual numbers etc better than anything else I've read on the subject.

[CCRider]

https://www.theguardian.com/world/20...y-ill-patients

Plasma extracted from cured patients seems to be helping critical patients to recover
Points to note
-Not all cured persons will have enough antibody density to be an effective donor
- Was reading somewhere that plasma from one donor will probably be only enough for 2-3 people. Scaling is going to be difficult.
But considering that 90% of the people recover, it may be possible to get enough plasma from those to help prevent deaths for the other 10%

This is even more reason to get the antibody test out quickly as it will tell us whether a person has already been infected and is producing the antibodies.

Maybe Dr. Vivek can provide more info on how feasible this treatment can be on a large scale.

[GrammarNazi]

Govt had earlier announced free COVID-19 testing under Ayushman Bharat scheme - it'd benefit about 50 Crore poor people.

In my personal opinion, this wasn't the ideal scenario, because

• Businesses with a chalta hain attitude too may compromise to cut corners and employ people who may not be tested if they're not enrolled with this Govt Scheme - this would leave the public vulnerable as COVID-19 is extremely contagious & can spread fast.
• Middle class is known to often compromise on things either in the name of genuine personal sacrifice,
• I'm not being cynical and REALLY DO respect medical staff for their work, but to be pragmatic IMO private testing labs that could charge for tests (the price-cap is at Rs.4,500/-, but that could very well just be temporary) could possibly milk the lower-middle class. Also, patients and doctors may require to check the results multiple times before, during and after treatment for COVID-19.
• Poor people would generally have no option to appeal against possible faulty testing and this could hit accountability that controls procedure necessary for accuracy. Also, the Nasal Swab test may be only 98% accurate by their very nature.

So, IMHO it was rather pleasant to know that the Supreme Court of India has directed that labs would not to be allowed to charge for COVID-19 tests, and that the cost reimbursement would be tackled later by Govt.


IMO this could be beneficial in a few ways

• Adequate testing will ensure the general public is not negligent of their health. It could also help with regulations for retail/other businesses to employ only people with a -ve result.
• The virus is contagious & may spread again in repeated waves and those not affected now are potential future victims as their immune system would not have developed anti-bodies to fight the virus.
• AFAIK testing labs may decide not to offer the service of COVID-19 Testing & continue using their resources for their regular services as before. Although this may reduce capacity in the short term, it ensures that a person who may have contracted COVID-19 would not come into contact with others who suffer from pre-existing medical conditions even when visiting the testing labs. Infact the social distancing norms which would've been compulsory at private path labs - thereby reducing their capacity - would have a poor impact on the healthcare system.
• Since those being tested could be individuals with access to the justice system, the testing facilities would know that there is minimal/no scope for negligence, thereby reducing any laxity that could possibly develop in the system.
• IMO if it was a paid service, it could lead to a false sense of security among the people that others would've obviously gotten tested. (I say this having often seen rich people with multiple cars drive around with broken tail-lights of their cars for a long time - because they skimped spending on insurance.)
• Its not a long shot to realise that if it was a paid service, some who could easily afford testing could happen to decide to avoid people who they thought couldn't afford testing, thereby possibly creating class discrimination within the country & thereby possibly causing social distress.

The same issue about chargability may crop up when the COVID-19 vaccine is out. IMO Since the country is facing a contagious virus that does not differentiate between citizens, its necessary that the vaccine too should be administered similarly.

IMO We will need to afford this cost as a nation, just as we currently do for vaccines administered to infants.

Attaching the Judgement Copy.

[PaddleShifter]

Originally Posted by CCRider

But considering that 90% of the people recover, it may be possible to get enough plasma from those to help prevent deaths for the other 10.

I have seen similar procedure for dengue patients. Its called "Single Donor Platelet (SDP)" transfusion where using "apheresis" technique, platelets are removed from donor and given to the patient.

Almost all major medical colleges in India have got machines to do "plasmapheresis" for the purpose you described above in your post. As an example, we have a machine in AIIMS Jodhpur that removes cholesterol from blood. So, what I mean to say is that we can do this as there are many more similar procedures being done already. I have explained above procedures in simple langauge and steps.

The bigger challange is to prevent bloodborne infections such as HIV, Hepatitis B, Hepatitis C besides many other. For this reason, it is usually reserved for critically ill patients as a life saving procedure where risk to benefit ratio is far more favourable to carry out this procedure. 2 billion people around the world carry evidence of Hepatitis B infection (present + past/cured combined).

This plasma therapy has been used in the recent past for Ebola in Africa.

Another issue is the availability of donors. The numbers of recovered patient rise slowly especially during the early/exponential part of the curve if you observe closely. Among those who have recovered, donors need to come forward, undergo screening for suitability for donation and only then we can have a substantial pool of donors to do this on a mass level.

Edit- Found this link that explains everything related to plasmapheresis wrt covid-19

https://www.hopkinsguides.com/hopkin...9__SARS_CoV_2_