[lapis_lazuli]

If you have listened to Modi's speech, one statement that will invariably be misinterpreted and intentionally that :

"I urge the youth to form small committees to ensure adherance to COVID protocols. Then we will not need restrictions to curb COVID-19, let alone lockdown,"

Unleashing the unruly: I hope he hasn't done that inadvertently! We have enough vigilantes already!!!

[poloman]

Originally Posted by Lobogris

I




Sir, you are possibly confusing the infection rate with mortality.

Let me try to use an analogy near to our hearts. If we created hysteria that driving is very dangerous as over 200k people die in India every year and over a million are seriously injured. Now would we stop driving completely? We should obviously take all reasonable precautions like driving carefully, purchasing the safest car possible, wearing our seat belt and perhaps further reduce the risk by taking the train or plane for longer journeys. However very few would become so petrified as to never starting a car again. Same is the case with covid. We should wear masks, N95 in crowded areas, avoid spending a lot of time in crowded places and so on but to instill such terror that we completely lockdown the whole country and get afraid to even step out for a walk in an empty garden is a bit extreme. I repeat, none of this means we should not take all possible precautions. No one is advocating that at all.

I am not at all confusing infection rate with mortality rate. We all know severity of highly infectious disease like Covid is not limited to the mortality rate. This will clog your healthcare system. If suddenly you have millions of infected people, no country even developed ones will be able to manage the healthcare. Even 1% needing oxygen and 0.1% needing ICU will lead to major chaos like what we are seeing.

Have you seen accident victims clogging the health system anytime? You may have more deaths due to accidents. But in case of Covid, 10 times that number may need hospitalization. A critical covid patient may clog a ventilator for 10-15 days and recover. But in the process, several needy people will be deprived of ventilator. If there is a collapse of health care system and hospitals not able to follow proper treatment protocols, Covid fatality and fatality due to other diseases will zoom out of control. This is a viscous cycle.
There is a reason why you call a pandemic a pandemic.

Heard some people criticizing, why can't we have universal vaccination for all? Do these guys even know the enormity of producing 1.3B x2 vaccines and administering them? So much time they wasted in criticizing the potency of the same vaccines. Now they want immediate vaccination of entire populace.

[headbanger]

Government isn't any saint. Take the example of Punjab and Haryana. Similar size, similar population and similar demographics. Have lived my entire life in these states. And now look at the number of deaths (3.4k vs 8.5k)of both states. Who is faking numbers now OR covid has taken a liking to Punjab for a specific reason? Either Haryana is under reporting or Punjab is over reporting or may be both. All that's being shared is anything but truth.

When did we get the second wave? April 2021, almost a year and a half after this pandemic started. Yet, we were grossly unprepared. The truth is the common man out there on the street has been torn to smithereens by politicians,be it the state or the central government.

And for all those folks, doctors or laymen, who feel there is unnecessary hysteria, I hope we reach that day very quickly when this hysteria dies for the right reasons. Anyone on the ground knows what is the reality. The sirens of ambulances and the wails in the crematoriums don't need any online links to show the hollowness of the information being passed as news or opinions.

As for ICD 10 codes being used by Indian Healthcare system, God bless all who believe that they are used in right spirit and conduct. I deal with these codes daily, so I know how should they be used versus how they are dealt in practice across.

[tsk1979]

Originally Posted by poloman

Heard some people criticizing, why can't we have universal vaccination for all? Do these guys even know the enormity of producing 1.3B x2 vaccines and administering them? So much time they wasted in criticizing the potency of the same vaccines. Now they want immediate vaccination of entire populace.

Yes this is the problem. They have no clue. There should not be 1.2Billion vaccines from a central source. But rather state by state with every state being the hub.

India is a huge country, the second largest in the world when it comes to number of people.

You cannot have central solutions. Every state needs to be its own unit.

Manufacturing can be sorted. . You need smaller state level hubs with manufacturing contracts and deals in place when vaccines were being developed in 2020, not January 2021.

Look at the timeline for India vs the world
https://www.telegraphindia.com/india...ss/cid/1812969

[Arun_S]

Originally Posted by jetsetgo08

Query to the Doctors in this thread.

Could it be possible that a vaccinated individual infect others?

Not a doctor, Quoting from what Chair Person of Bharat Biotech said
https://www.livemint.com/companies/n...936384444.html

[avishar]

Originally Posted by poloman

Gross under reporting of cases not surprising anymore.
Official death count in whole of Gujarat on April 16 : 78
Investigation found 689 deaths just in 7 cities.

https://www.thehindu.com/news/nation...le34352916.ece

Now extrapolate this on a national level, you will get the right picture. Actual deaths will be more than 20K daily. This will be also close to what you see around you.

That is quite a number since that would mean almost twice the number of people are dying on a daily basis than average deaths. The average deaths per day in India is approx 25000~.

Could be true too, difficult to tell these days.

If it is true, it will have a noticeable impact on population, atleast on a hyper-local basis.

[srishiva]

https://www.rediff.com/news/intervie...p/20210421.htm

Agree so much. US has no dearth of experts/technology/money and the leadership lead it to a disaster. India is same too. Look at NZ, Taiwan etc. they have someone who might listen to experts. Not sure who said political leadership means you know everything and do what you want.

[Akshay6988]

Originally Posted by lapis_lazuli

If you have listened to Modi's speech, one statement that will invariably be misinterpreted and intentionally that :

"I urge the youth to form small committees to ensure adherance to COVID protocols. Then we will not need restrictions to curb COVID-19, let alone lockdown,"

Unleashing the unruly: I hope he hasn't done that inadvertently! We have enough vigilantes already!!!

At the risk of going off topic or getting too political, I think he said it intentionally. He knows his supporters will do anything he says to upkeep his image. Anyone getting those "spread positivity" messages on whatsapp groups recently ?
Just for once why can't he take the blame for his failure to handle covid situation. Rather than rambling about the covid caller tune, he could have come up with a solid plan that would actually work. It's almost an year and half since covid hit country, and yet both state and Central government failed spectacularly to prepare the healthcare system. And I sincerely hope no unemployed youth take up the mantle to form any such committee to harass common man. We have police doing that job, and I think they're enough.
Mods delete this if inappropriate.

[mvadg]

I don't know if the following essay has anything to do with the coronavirus pandemic in particular, but I found it an interesting and thought provoking read. I only wish all decision makers had the kind of insight Dr. Robinson has into her own thinking and biases when deciding for society at large.

How One Epidemiologist Decided Whether to Send Her Children to Group Childcare
How to reason when information is incomplete, uncertain and emotionally-fraught


This issue of Insight is a phenomenal guest essay by Dr. Whitney Robinson on how she navigated the difficult and complicated information landscape early in the pandemic to puzzle through whether to send her two children to childcare. She explains not just her decision, but the underlying principles she used to evaluate uncertain and incomplete information (the meta-epistemology!) in order to arrive at a conclusion, including how she used existing knowledge to try to find the right questions to ask, how she evaluated absence of evidence of certain kinds of events despite high demand (an approach related to this earlier post) and the steps she took to try to guard against her sticky priors (like all the research on influenza and kids) to better look at what was in front of her.

I really love this piece because it is an excellent example of how to provide really useful tools and information to help people make their own decisions, without implying there is a single right answer that fits everyone, or that every other choice was wrong. And the real treat here is that the methods and principles she’s explaining are applicable in a great variety of contexts.

Without further ado, here’s the essay (and see you in the comments!).

More on meta-epistemology: an epidemiologist’s perspective

by Whitney R. Robinson, PhD, MSPH

Associate Professor of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health

In the January 31 issue of Insight, Zeynep wrote: “Reflecting on these anniversaries also offers a chance to talk a little bit about metaepistemology: the theory of theory of knowledge. Why did we know what we knew? Which in turn explains: why did we miss it?”

I ate this up and apparently many other Insight readers have, too. Your interest in this topic is likely a reason that Zeynep gave me this opportunity to write about meta-epistemiology from my perspective as an epidemiologist.

My love of meta-epistemology (how we know what we know) likely attracted me to epidemiology. Epidemiology is one of the fields within the health sciences that is uniquely comfortable with uncertainty. Other health fields seek out universal principles. For instance, one of molecular biology’s stunning insights is the double-helix shape of DNA. That shape and structure is a near-universally applicable insight on the nature of life on Earth.

In contrast, one of epidemiology’s hallmark insights is that chronic tobacco smoking greatly increases risk of death from lung cancer and cardiovascular diseases. It doesn’t sound quite as cool. However, with that knowledge, I can reliably predict that, when a lot of people in a community start smoking, in a few decades, that same place will reckon with a greater number of painful cardiovascular illnesses and deaths than they otherwise would have. Unfortunately, I can’t tell you exactly for whom the smoking will make a difference. I can’t tell you which person will smoke for 75 years then die peacefully in her sleep, or which person’s fate was shifted towards an earlier and harder end the moment she picked up her first cigarette.

Because epidemiology can have a fair degree of certainty on the population level but not for the individual, we traditionally make big sweeping recommendations for everyone with the goal of preventing tragedy for an unknown subgroup. We propose measures that we believe will save lives -- but we usually don’t know which lives. That’s a central tension in the field: asking for collective behavior change that may or may not directly benefit a given person or family. The idea is that certain collective actions will benefit many more people than they harm, but we can’t promise that any one person will directly receive more benefits than harms.

Temperamentally and by training, I’m pretty comfortable with this level of knowledge -- the big-picture population kind of knowledge that sits alongside a lot of uncertainty at the individual-person level. And that’s all well and good until you’re a working parent in the middle of a pandemic. It’s all well and good to say, “On the one hand this, and, on the other hand, that,” until you need to make a decision for your own small children, as well as their constellation of caregivers and family members. It’s all well and good to say, “Well, it depends,” until you are in a situation with little trustworthy national guidance and you actually do need to make a specific decision for your loved ones.

I’ve written on Twitter about my decision in March 2020 to keep my two young children (1 year old and 5 years old) in group childcare. I feel lucky that I had the option. But keeping them in daycare was a pretty out-of-step decision in my social circle at the time. One day my toddler was the only child in his classroom. It was just him and his two teachers. I’ve talked about my decision publicly over the past year, on Twitter and on my podcast, but I’m not trying to convince anyone else to make the same choices. If I’d been in different circumstances, such as having older relatives living in my household or in a job where I couldn’t risk a two-week daycare quarantine, I might have made a different decision. I’ve talked about my decisions because I was talking about my research life publicly. I couldn’t do that in good conscience without acknowledging the support I was getting through paid childcare. So many families, especially mothers of young children, have dealt with huge levels of gaslighting and burnout over the past year. I didn’t want to ignore the impossible trade-offs many families with young children faced because of the lack of a social safety net. I also wanted it to be clear what trade-offs I was making to reduce the risk for myself and the other members of the daycare community (e.g., no podding, no indoor activities with anyone outside our immediate family, purely outdoor meetups).

Because this was a tangible decision that I made early in the pandemic, when research was limited, I thought it was a good example for Zeynep’s meta-epistemiology series. When almost everyone else was keeping their kids home, how did I decide to send mine to daycare? In the spirit of Zeynep’s previous posts, I will answer that question using 3 principles.

Principle 1. “Look to previous phenomena to know what questions to ask”

I’m not an infectious disease epidemiologist, but I had enough basic knowledge from my PhD training to know what questions to ask. As a student, I learned two important things about the dynamics of another respiratory infection, influenza. First, I learned that, with respect to age, sickness (morbidity) and death (mortality) typically show a J-shaped curve. The very youngest (especially infants younger than 12 months) and oldest are mostly likely to die of influenza during an outbreak. The very oldest (75 years+) suffer the highest rates of flu death. In a typical flu season, school-aged children and young adults are at the least risk. So my first question was, are young children likely to get very sick or die during a COVID-19 outbreak?

But when I was an epidemiology student in the early 2000s, I’d also absorbed the lesson that groups at low risk of morbidity and mortality could, counterintuitively, be high-risk transmitters. This insight was exemplified by studies like this 2001 New England Journal of Medicine article which concluded that vaccinating school-aged children in Japan prevented flu deaths in the elderly. The article determined that stopping that school vaccination program resulted in a big increase in influenza deaths among the elderly. Even though school-aged children faced low risk of death themselves, they were a key driver of flu deaths for older people. So my second question was, are young children especially likely to spread COVID-19 to other people?

Principle 2. “Observed versus expected." In other words, “Pay attention to unexpected data that has no natural constituency and to lack of data that are in high demand”

The best sources of data about morbidity and mortality were hospitalization and mortality data from China and hard-hit countries like Italy. And the data were consistently different than the classic J-shaped mortality or hospitalization charts of the flu. Instead, hospitalization and mortality rates increased exponentially with age. In fact, mortality for the youngest children was similar to that from flu. That was a helpful anchor for me in thinking about absolute risk to young children.

Understanding children’s contribution to transmission in childcare and school settings was more complex. There was not going to be a randomized controlled trial or enough time for a natural experiment like Japan’s experience with changing school vaccination policy. Instead, I triangulated among multiple data sources. First, I wanted to understand infection: there’s no transmission without infection. US surveillance data were useless because of limited and haphazard testing. To understand age-specific infection risk, I relied on places like Iceland and the Faroe Islands that were conducting representative or extremely widespread testing of current or past infection, regardless of symptoms. When places conducted this kind of testing early on, before the most at-risk groups knew how to protect themselves, young children consistently had low prevalence of infection. (In China, schools had been closed when the outbreak came to light, but the same wasn’t true in all other countries.) Then there were the household studies. The strength of these studies is that the researchers study a family in which at least one person is infected. Everyone in the family is exposed and presumed to be at high risk of infection. Age differences in which family members get infected tell us about susceptibility to infection. There are lots of these studies now. The early ones weren’t all perfectly conducted, but they consistently indicated that the young kids in these families were least likely to become infected when there was a positive family member. And there were also early indications that they were less likely to be the index (or first) case in a household as well.

I gave these studies a great deal of weight because the results were unexpected, consistent, and seemed to please no one. There was no natural constituency for the narrative that kids under 10 years old in particular definitely could get infected but were much less likely to get infected and transmit than older people. It was an oddly specific finding that no one had predicted or set out to prove. Because the particulars were so unexpected and seemed to serve no one, I believed they were likely to be valid.

On the other hand, by late March, there was a huge demand for another type of story: news reports of COVID-19 spreading in schools and childcare centers. I am a member of several Facebook groups for academic researchers who are mothers. The members of these groups were hungry for information on children and SARS-CoV-2 transmission dynamics. As I watched the same stories circulate again and again in March, I became convinced that the many childcare centers and primary schools that remained open across the country were not producing an outsized number of outbreaks. Many of the stories I saw, besides being rehashes of the same incidents, stretched the truth to make it seem as if children were fueling outbreaks. There would be a headline about 20 cases among teachers in a school district in Georgia. But when I read the article, the spread would be among teachers gathering in a building for a meeting among themselves or to teach remotely. I saw multiple instances of COVID-19 outbreaks among adults conducting remote teaching purposely given headlines that implied that schoolchildren were involved. This told me that the media knew there was strong demand for stories of children at risk for COVID-19 in childcare settings and that there weren’t enough verified outbreaks to meet that demand.

There were alternative explanations for the relative lack of stories of daycare-based outbreaks. As I mentioned earlier, testing was extremely limited in the U.S. in late winter and early spring 2020. That meant cases among children would be easy to miss. However, if cases were spreading quickly from childcare centers to families, I would expect some of those to result in severe illness among family members and lead to contact tracing. Because childcare and school settings were seen as high-risk early in the pandemic and as critical infrastructure for first responders, most local public health agencies would have prioritized a possible outbreak at a school setting. Further, schools and childcare centers are among the few settings that had existing infrastructure for infectious disease disease reporting before the COVID-19 outbreak. For instance, in North Carolina, the only entities obliged by law to report known cases of communicable diseases are school principals and childcare operators, physicians, restaurants, and operators of scientific laboratories.

Both childcare and restaurants are highly regulated businesses, but childcare facilities are even more likely than restaurants to detect and report a case because the population it serves is fixed and has ongoing relationships with the center. If a big group comes to a restaurant and a presymptomatic diner infects others in his party, the restaurant owner would have no way to know. However, if a child stopped showing up at daycare because family members were sick, the daycare operator is likely to find out. Even with the challenges of limited testing and anecdotal evidence of some families hiding children’s infections, the demand for news stories about kids and COVID-19 in schools, ongoing relationships that schools and childcare centers have with families, and the data infrastructure of reporting that preceded COVID-19 convinced me that many school-based outbreaks would receive the wider attention if they were happening on a frequent basis.

Footnote 1: And then there was this case study about families on ski vacation in the French Alps in February. A thorough contact tracing effort found that an infected child did not transmit to anyone despite many school-based contacts at 3 different schools. It’s totally anecdotal, but travel envy really got this scenario stuck in my head.

Footnote 2: Despite the evidence, many people remain convinced that school settings can’t be safe because they’re environments where so many people are indoors together. I think this is where exponential growth frustrates intuition. Why would it be safe to have a bunch of bodies indoors in one context but not another? The way I think of this is the way I think of more infectious Variants of Concern, like B.1.1.7. Even with only 15% more transmissibility, a Variant of Concern could catalyze a huge increase in virus spread because of the counterintuitive math of exponential growth. But it goes the other way too. A population, like young children, that is ⅓ or ½ as likely to get infected or spread disease, can experience an exponentially lower level transmission together than adults doing the same tasks.

Principle 3. “Beware of ‘sticky’ priors”

A major topic of conversation in Zeynep’s newsletters has been why expert consensus got some important things wrong at first. I have two thoughts on this. First, experts are human and can get too attached to knowledge gained in other settings. I think that some types of knowledge are particularly “sticky.” For instance, counterintuitive facts that we learned during formative stages of training, such as the Japanese school-aged flu transmitters, can be particularly hard to let go. Also, observations that are reinforced by personal experience often have outsized weight when we are evaluating new situations.

With regard to COVID-19, I didn’t have a lot of strong priors because I had never worked in infectious diseases. But I have worked a lot in racial inequities in non-infectious diseases and also in fields like obesity and cancer. Because of that work, I did have strong priors about the causes of racial inequities in COVID-19 and obesity as a risk factor for COVID-19 mortality. My priors about racial inequities were mostly correct. However, my skepticism towards obesity as a risk factor likely underestimated its riskiness. That’s the thing about strong priors -- sometimes they are a shortcut to truth, sometimes they mislead. And it’s difficult to predict when one’s hard-won scientific intuition will be prescient and when it will be foolish.

Another potential explanation for notable failures to integrate new data quickly and shift thinking is exemplified by this article: “Does Science Advance One Funeral At A Time?” I often think of this article. Its central premise is that a few star senior scientists can impede the flow of powerful and novel ideas in whole areas of inquiry. As explained in this summary in Science, the effect can be intangible and even inadvertent. Phenomena include “Goliath’s shadow,” “intellectual closure,” and “social closure.” I’ve worked in fields like this, where a dominant paradigm is so strong that it feels impossible to get a foothold for an alternative direction for research. Advancing a new way of seeing things -- even if that alternative view is pretty obvious to an outsider carefully looking at the data -- seems to hit roadblock after roadblock or just get ignored. In these circumstances, one has to become near fanatical to break through. I’m not sure if this is the case with some areas of infectious disease. But, for better or worse, scientific micro-communities have cultures just like all other communities.

Conclusion

When people ask me my opinions about COVID-19 and kids now, I mostly demur. On the one hand, I’m still sending my younger child to our longtime daycare. And my older child is now attending in-person kindergarten. We are still cautious in our daily lives, but we will see extended family soon (all adults are vaccinated) for the first time in over a year. Here are some reasons why I feel pretty confident about my kids being in in-person group childcare. Vaccination rates are high among the staff at the daycare and the school. Mask compliance is high in both settings. Both settings have very long, evidence-based handbooks of their safety procedures. For instance, although my kindergartner eats lunch inside at his school, mask-off time only lasts 10 minutes and is silent: the teacher puts on an episode of The Magic School Bus. The kids are riveted.

However, the justifications in the previous paragraph are not the whole truth. The rest of that truth is that I’m leaning on my priors now. I haven’t done a comprehensive review of the literature since summer 2020. Instead, my decisions today are heavily influenced by my priors from my deep investigation last spring. The truth is, I made a decision a year ago that worked out well. That experience has reinforced my beliefs.

But things are different now than they were in March 2020. Now we know about Long COVID and MIS-C. There are more infectious variants and some with potential to partially evade vaccines. But there are also amazing vaccines. They are so, so remarkably powerful. When I do quick mental math, I assure myself that the high vaccination levels in our community, my family’s continued precautions, and the thoughtful precautions at our daycare and school mean that my family and school staff remain at extremely low risk of infection. But I also know that I am taking a mental shortcut. I hope you’ll have some grace for me. It’s been a long year.

[am1m]

Originally Posted by mvadg

I don't know if the following essay has anything to do with the coronavirus pandemic in particular, but I found it an interesting and thought provoking read.

Sir, you are just asking for too much! I need to read through a looong essay from a qualified epidemiologist stating facts which also leaves the onus on the reader to weigh and decide on the facts and whether they may apply or not to our country and our situation?! Too much I say! No competition between something like this and a panic-inducing whats app forward/media report sent from my resident RWA-uncle that panders to my inherent biases and gives me quick points to argue with anyone, even doctors who are actually seeing patients.

But nevertheless, thank you for the useful post and thank you yet again to our resident doctors on this thread for continuing to post and attempting to educate us in spite of ourselves!

[V.Narayan]

Very nicely captures the current situation👇👇

Boats in a storm

We are all navigating a storm, but not in the same boat

The waves may capsize yours while gently rocking mine

Or vice versa

For some, quarantine is a moment of reflection, of re-connection. Easy, in flip flops, with a glass of whiskey in hand

For others, this is a desperate crisis

Some experience it as loneliness and isolation

Others a time of reconnection with family and friends

Some lament the absence of a brand they love

Others worry about bread for the weekend, or if the noodles will last a few more days

Some work in their "home office"

Others have lost their homes and offices

We criticize those who break the quarantine

But some have no choice, they have to pay the bills.

Others choose to escape. To their country homes or favorite vacation destinations

Some have experienced the virus, some have already lost someone from it, some are not sure their loved ones are going to make it

And yet there are some who don't even believe this is a big deal

Many are getting vaccinated. Some have faith in God and miracles. Others lack faith in science

Some think the storm is passing, others think the worst is yet to come

So, friends, we are not in the same boat. We are in the same storm. How we perceive it depends on the boat we are on

And when the storm passes, each of us will emerge, in our own way. Some stronger, some unscathed, some scarred, some on a stretcher, and some will not make it.

It is very important to see beyond our own experience

See beyond our politics, beyond religion, beyond race, beyond the nose on our faces

Do not underestimate the pain of others even if we do not feel it ourselves

Do not judge the good life of one nor condemn the choices of the other

Let us not judge the one who lacks, nor the one with possessions

We are all simply on different boats

Let’s navigate our routes with respect, empathy and responsibility

--Author unknown

[paragsachania]

Originally Posted by lapis_lazuli

"I urge the youth to form small committees to ensure adherance to COVID protocols. Then we will not need restrictions to curb COVID-19, let alone lockdown,"

Covid sub-committees have always been part of apartment associations since quite some time now.

This has been done to ensure that the sub-committees' focus is only on COVID and nothing else. Our own apartment has one and so I see such committees in the neighborhood gated layout too.

All said and done, the ball is in our court now if we need to break the chain. I still see youngsters casually sitting on a bench with a cuppa and smoking at a typical bakery in Bangalore that sells no bakery stuff (many will know these bakeries I am referring to).

During the last wave, the concern was getting infected. During this wave, the concern is what if I need to get myself admitted. Look at the way our healthcare system is overwhelmed including testing centers that are delaying the results beyond 72 hours (till then damage is done).

We don't need a lockdown and that is the general sentiment unless you want to see more and more businesses succumb and daily wagers suffer. So what else can we do? We better have self imposed lockdowns as much as possible and this is exactly the need of the hour. We also heard our PM refer to micro-containment zones for the same reason so a small area getting affected shouldn't influence the whole neighborhood or the town.

[srvm]

My 2 cents on the Covid 2nd wave and current precarious scenario in most cities/states in India. I write this mostly because I had a discussion with my colleagues at work yesterday about this topic (no WFH for us).

One colleague remarked/asked others: Why do you guys think the 2nd wave is here? Things were so much under control just over 3-4 weeks ago. Why? What went wrong?

I thought about it and this was my response to him:
In one word: Indiscipline. Many people abandoned social distancing, masking, etc once the 1st wave was on its way down. Usual "chalta hai" attitude or "oh! it wont happen to me" attitude. At least, I understood that our countrymen cannot be relied upon to do the right thing even during desperate times, even if it means protecting/saving ones own's life or of others around him/her. We have seen it elsewhere in the forum on threads on Accidents or Bad Drivers: Junta driving on wrong side of highway to save 2 minutes; Jumping red signal because no cop was around; Not wearing helmet because I'm only going around in the neighborhood; Spitting in public areas; Can't bother to follow queues anywhere; Throwing garbage everywhere from cities, national parks, monuments;

Bottomline is we as a society simply don't have the discipline to do the right things most times. And our politicians, bureaucrats etc are just a microcosm of our society. So, no point expecting them to do things right in the face of a crisis/pandemic.

And this indiscipline was not culled when it was a mere sapling a long time ago. Instead, majority of people watered it, nurtured it for years to a point where it is a big, strong tree. A tree that cannot be uprooted in a matter of weeks/months during a pandemic. Now, we live at a time when rule/law breaking is the norm and the rule/law following is the exception.

My colleague after listening to my above response/rant, put on his covid face-shield instead of a helmet and rode home in his 2-wheeler. Before I open my mouth to tell him for the nth time to wear a helmet, he looks at me and tells this before zooming off: Arrey baba! My home is just 1-2 km away. Nothing will happen.

[Zen2001]

Originally Posted by poloman

I merely pointed out the hypocrisy in your posts. On one hand you are telling you don't believe in TV, news or social media and on other hand you are quoting multitude of links from online media. So who decides which source is reliable and which ones not.
As a doctor why don't you provide details for which you have first hand information. Does your hospital has enough COVID beds? ICU beds? What is oxygen situation? How many cases you are seeing on daily basis and how many deaths?
For example there are reports that only hours of oxygen left in most hospitals in Delhi. Can this be true?

There is no question of hypocrisy. Even if my links point to online media, I make sure their content is corroborated at least as per the medical aspects concern, which I am in a position to check. Even so, that doesn't mean I blindly quote from medical journals assuming their veracity - my references to such articles have been only after cross referencing. I don't decide reliability of information, but instead apply reasoning and my knowledge of the subject to conclude whether these are likely to be correct or otherwise.
Regarding first hand information, I have also mentioned the scenario in hospitals I work and others I get information from - the system is strained beyond capacity, but largely due to lack of anticipation. Any private hospital can't keep a 200 bedded facility operational (and otherwise unutilised) hoping for a pandemic. I am aware of the operational cost per bed per month - whether occupied or not. Even though government hospitals have increased capacity in the past decade, they have bureaucratic problems of their own - that's not my subject. That's why we have make shift Jumbo hospitals, which also ironically have been leased to private entities instead of government taking its own responsibility. I need not say what happens further. Lastly, the scare has resulted in many mild cases occupying the already limited beds, (not talking of ICU) using contacts of local politicians and money. And patients demanding oxygen and medications of their own will has compounded the limited resources of the same.

Originally Posted by Nissan1180

This article is about how the death numbers are fudged. Mortality rate is low because the ingenious babudom has discovered new ways to reclassify the deaths. Their actions are unthinkable by the normal standards of humanity. They are storing bodies in a morgue for a few days so that reported numbers are low. This is besides the underreporting by making cardiac issues etc. responsible.

I called up almost every dealer of oxygen cylinders, concentrators and cans in the city where I live and only 3-4 had products available, that too being sold at a premium. All this happened because the bureaucrats were busy fudging numbers to get their promotions and no thought was spared about making people realize that covid is not gone.

Across India, even now many schools are open for teachers and many companies are forcing people to report from office. There are instances where covid positive people are being made to come to office to work. All this is hidden away by a criminally corrupt and spineless national media.

Vaccines don't seem to have worked as intended in many cases.

Dead bodies are temporarily stored in morgues for various other reasons - not for underreporting - the death already has been certified before that. The treating doctors are in the best position to ascertain primary cause of death with co existing covid infection - death with a covid positive report may not necessarily due to covid. No new system has been developed in the name of covid - the same system as before is being followed, as there's nothing wrong with it.

When demand outstrips supply, the issues of hoarding, blackmarketing, etc will always happen - this is abundantly seen in all other fields. The administrative powers need to control these issues before they even crop up. If covid positive people are being forced to report physically to work, or others too, when specific restrictions are in place, criminal cases can be registered - irrespective of media reporting.

Vaccines have only worked to the extent they were researched. In all the fast tracking, no one bothers to read the fine prints. Those who believe vaccines will end covid (for now at least) are living in a fool's paradise.

Originally Posted by poloman

I am not at all confusing infection rate with mortality rate. We all know severity of highly infectious disease like Covid is not limited to the mortality rate. This will clog your healthcare system. If suddenly you have millions of infected people, no country even developed ones will be able to manage the healthcare. Even 1% needing oxygen and 0.1% needing ICU will lead to major chaos like what we are seeing.

Have you seen accident victims clogging the health system anytime? You may have more deaths due to accidents. But in case of Covid, 10 times that number may need hospitalization. A critical covid patient may clog a ventilator for 10-15 days and recover. But in the process, several needy people will be deprived of ventilator. If there is a collapse of health care system and hospitals not able to follow proper treatment protocols, Covid fatality and fatality due to other diseases will zoom out of control. This is a viscous cycle.
There is a reason why you call a pandemic a pandemic..

I agree. The system is already "clogged". With the existing mortality rates from covid and other non covid chronic/acute diseases, it has already been shown that non covid mortality will easily outstrip covid mortality as early as 2021. But who's counting that?

Originally Posted by headbanger

Government isn't any saint. Take the example of Punjab and Haryana. Similar size, similar population and similar demographics. Either Haryana is under reporting or Punjab is over reporting or may be both. All that's being shared is anything but truth.
The truth is the common man out there on the street has been torn to smithereens by politicians,be it the state or the central government.

And for all those folks, doctors or laymen, who feel there is unnecessary hysteria, I hope we reach that day very quickly when this hysteria dies for the right reasons. Anyone on the ground knows what is the reality. The sirens of ambulances and the wails in the crematoriums don't need any online links to show the hollowness of the information being passed as news or opinions.

As for ICD 10 codes being used by Indian Healthcare system, God bless all who believe that they are used in right spirit and conduct. I deal with these codes daily, so I know how should they be used versus how they are dealt in practice across.

Government policies seem to be suspiciously motivated. As a result the straightforward ones probably suffer the most. Whether necessary or unnecessary, hysteria will not get us anywhere. This is what the politicians have their finger on and this is what they use to manipulate is. You can take the horse to the water but you can't make it drink - when there's a worldwide system of reporting deaths and you have it at your disposal, you are only to blame if you can't/won't use it properly. As per my experience, we always have; that's all I can say.

[DigitalOne]

The curious case of Remdesivir. I remember last June-July, when the drug (originally developed for SARS-Cov-1, and repurposed for SARS-Cov-2) started making waves with limited trial data.

(I admit, in my naivete, that I have posted couple of news articles on Remdesivir in this thread back then ).

And then in November, Remdesivir was shown as not effective to reduce mortality or severity, and removed from WHO's list of recommended treatments.

But now without any new evidence, it has been resurrected and how! Every layman and his Whatsapp uncle is recommending Remdesivir, and doctors are being forced to prescribe this "miracle" cure.

So what's behind this Remdesivir hysteria? Is it a case of Indian pharma cos, who would have paid a fortune to Gilead Life Science last year to get manufacturing license, creating a hype to recover their investments ??

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Sources:

The Strange Story Of Remdesivir, A Covid Drug That Doesn’t Work

Explained: What’s Remdesivir And Does It Cure Covid-19?

WHO recommends against the use of remdesivir in COVID-19 patients