[Chetan_Rao]

Choose your own experts to believe, but please factor in the perspective that handling a pandemic takes multi-disciplinary expertise to come together.

A medical expert is probably as ill-equipped to understand the broad socio-economic impact of a pandemic as an economist is to the medical aspects of avoidance/containment/treatment. Both probably have minimal administrative knowledge to mobilize resources and implement measures at ground-level.

Believe or dismiss whoever you choose, but don't forget no expert of any one field is going to get us through this. We need the district administrations and in-the-field cops as much as we need the scientists in labs, and everyone in between, and they all probably have some critical input to keep our pandemic response on its feet and moving forward.

[skdking]

Originally Posted by hserus

Epidemiology and public health are multi disciplinary fields in which you need economics and graph theory as much as you need medicine.



"Biased BBC" really? .........

Just because we have cartoons running our news (cum entertainment) channels does not make BBC a paragon of virtue.

Of course BBC is not the most biased out there but their tone of genteel condescension while reporting of India is infuriating.

But you are right about Indian TV. I have stopped watching news.

I watch cartoons along with my son now. Very much better.

[Samurai]

Originally Posted by LobsterB

So, I would like to keep an open mind about his views irrespective of his PhD in Economics.

He has co-authored 193 research papers in the area of public health and pandemics. So, he might know what he is talking about.

[A M]

Originally Posted by Turbanator

A quick question- what will happen after these 21 days or hypothetically after 90days of this lockdown.

Can the professionals (Doctors) confirm that by staying in isolation this will go?

When will the Authorities realize that the testing & taking out the infectious people is the only way. Else this is never going to get over unless we get help from some mythological gods and goddesses.

More than the medical doctors, this is more of a Public Health / Community Medicine domain.

Isolation will break the chain of transmission. The lockdown of 21 days is decided based on the incubation period of the virus i.e. 2 - 20 days. Majority of the cases that are asymptomatic will show up symptoms within this time frame. Given that people have not stuck to it religiously, the lockdown may be extended.

So within these 21 days:

1. Extensive contact tracing and quarantine of these contacts are needed. This is being done.
2. Once the positive cases are traced and localised, those neighbourhoods need to be sealed in a radius of 5 - 7 KMs.
3. Ramp up testing in high-risk areas i.e. the radius mentioned in point 2.
4. Ease out the restrictions in low-risk areas but only gradually while not allowing a gathering of more than 4-5 people for at least 90 days.
5. At the same time, set up isolation wards and ramp up the infrastructure in hospitals to accommodate COVID patients and as WHO advised, test test test as many people across the country.

A complete "back-to-the-normal" life will not start until we have a vaccine for this strain. This may take 9 - 12 months from now. Since there are cases that have reported relapse of the infection, "Herd Immunity" is doubtful till a vaccine is developed.

[Kuldeep31]

An interesting visualiser, as the name says, to know the current state of affairs across the globe:
https://www.covidvisualizer.com/
What beats me is how in China COVID-19 has been restricted to Wuhan province only. AFAIK, in all other affected countries the spread has been uniform.

[mvadg]

Originally Posted by ksameer1234

Doctor by virtue of PhD in economics

Originally Posted by Miyata

article (be a seemingly REAL doctor) -

Originally Posted by splitsecond

presenting him as an expert.

Originally Posted by LobsterB

I understand he is a PhD in Economics... a quick search on who.int seems to show them referring to quite a few of their studies and projects. ... a Master's Degree in Public Health (Epidemiology)
So, I would like to keep an open mind about his views irrespective of his PhD in Economics.

Originally Posted by doxinboy

His article appeared in The New York Times today titled "What India Needs to Fight the Virus" His credentials include apart from being the director of the Center for Disease Dynamics, Economics & Policy in Washington. he is also a senior research scholar at Princeton.

Originally Posted by hserus

Epidemiology and public health are multi disciplinary fields in which you need economics and graph theory as much as you need medicine.

Thanks guys, I too looked him up and his other videos. I think he is rational and scientific. I was a bit worried that I had recommended a quack, but he is definitely well within his field of expertise in this matter.

[LobsterB]

Originally Posted by A M

So within these 21 days:

1. Extensive contact tracing and quarantine of these contacts are needed. This is being done.
2. Once the positive cases are traced and localised, those neighbourhoods need to be sealed in a radius of 5 - 7 KMs.
3. Ramp up testing in high-risk areas i.e. the radius mentioned in point 2.
4. Ease out the restrictions in low-risk areas but only gradually while not allowing a gathering of more than 4-5 people for at least 90 days.
5. At the same time, set up isolation wards and ramp up the infrastructure in hospitals to accommodate COVID patients and as WHO advised, test test test as many people across the country.

This looks like an action plan. Media has been talking extensively about the first point, contact tracing and the last one, adding more beds etc. Have you come across the ramping of testing in high risk areas? In the last few days, I came across news reports of atleast three cases of infections where there was no travel abroad and local source of infection was not yet clear. It would have been reassuring if media had followed up and shown us what is being done in each of them as well.

[efgritesh]

In my opinion we don't have an exit strategy yet, isn't it.

I think what we might be overlooking at is that even if we corner every single person infected with the virus in India, what is the guarantee that we wont be having more imported cases in future. we cant ask Indian citizens staying abroad to overstay illegally once the lock down is over.

Some of us might say that we will have better screening of everyone coming from abroad, but then why we didn't do it in first place?

Experts please enlighten!

[aghate]

I see some questions raised about the credibility of the number of confirmed cases in India. It is indeed a good question, but we have to look at some of the major factors that contributed to the spread even before it went all ballistic in Europe.

People travel a lot in the EU, especially during the winter to enjoy the skiing in the Alps, etc. This is just a generalized scenario I am trying to present here so please bear with me. Folks travel to Alps, get infected, return to their native countries and infect others. When this was happening these countries were a bit late to act on the preventive measures to stop the spread. We all know so far, that the number of cases rise exponentially and quickly spiral out of control.

Then there is European football. You have weekly matches for the respective National Leagues(Premier League, Seria A, La Liga, etc) where thousands of people get in contact with each other. You have the UEFA Champions League which is one of the prestigious club football competitions where top football clubs across EU play against each other.

With the above two examples, you can imagine the number of interactions between players and fans and the amount of infections that may happen. The aftermath is in front of us today.

Below is a report about a Champions League game between Atalanta(Italy) vs. Valencia(Spain) in mid-February. Will quote an excerpt here,

Two of the hardest-hit countries in Europe by the coronavirus (so far) have been Italy and Spain, and two of their epicenters have been Bergamo and Valencia. Not coincidentally, those two communities came together for a certain Champions League football match on February 19 between Atalanta and Valencia CF, less than a week before the first official case was announced in the province.

“We were mid-February so we didn’t have the circumstances of what was happening. If it’s true what they’re saying that the virus was already circulating in Europe in January, then it’s very probable that 40,000 Bergamaschi in the stands of San Siro, all together, exchanged the virus between them. As is possible that so many Bergamaschi that night got together in houses, bars to watch the match and did the same.

“Unfortunately, we couldn’t have known. No one knew the virus was already here. It was inevitable.”

-Bergamo Mayor Giorgio Gori; source: FPA via AP

With over 40,000 in attendance at the San Siro (the match was played in nearby Milan since Atalanta’s home stadium in Bergamo does not meet UEFA requirements) and thus three communities directly affected, one doctor has called it a “biological bomb”, the “Game Zero” of COVID-19 in Europe, as dubbed by local media (playing off of the concept of “patient zero”, the first person infected by a given disease).

“I have heard a lot (of theories), I’ll say mine: Feb. 19, 40,000 Bergamaschi went to San Siro for Atalanta-Valencia. In buses, cars, trains. A biological bomb, unfortunately.”

-Fabiano di Marco, chief pneumologist; source: Corriere della Sera via AP

Source: https://weaintgotnohistory.sbnation....iological-bomb


Coming back to the question about the number of cases in India. The percentile of people travelling to Europe is considerably less in our nation. The GoI took immense efforts in the beginning to curb it as much as we could. Then we have some literate morons who have tried to avoid quarantine and later test positive for COVID-19. I have read about some ingenious ways that people have come up with to avoid getting caught in the screening. The only chance the infection would spread in India would be by someone who recently returned from any of the infected countries. Don't get me wrong, these people could have infected hundreds of others in the process but the scale at which it has impacted EU can be understood from the two scenarios I presented above.

Time will tell how bad or ok the situation in India will be. But the numbers from EU should be hammered down to knock some sense in the citizens and make them understand about the consequences. It is scary indeed if not controlled. I just hope that sense prevails sooner and we get through this a bit bruised rather than being battered.

Stay healthy and stay safe!


Regards,
aghate

[vivek95]

Originally Posted by V.Narayan

We owe a big thanks to member vivek95 for selflessly advising Team BHPians who seek information and clarifications. Thank you Doctor. Very useful posts.

Sorry for a very late reply, but thank you so much. I am doing my best to filter out correct information and post here. But I am no where close to being an expert unless I befriend the virus, spend quality them with it under the electron microscopes.

Originally Posted by nandadevieast

My question to Vivek95 And other informed members, sorry if this has been posted here:

The question is about community transmission of this virus.

I am told that india is testing for CV19 in a very small sample size. If you have a travel history with few countries and also the symptoms, then you will be tested.

At some point will they start testing all people with cough and fever? Like you could go to a lab and get tested for H1N1.

Though your question is a few days old, it still holds value. As you have pointed out, testing is still happening in a limited number of people due to limited resources. Until date, the travel history is still considered significant at many testing centres. Whereas I am personally not bothered about international travel history anymore. Looking at how people thronged at trains and buses just a day before Janata curfew, I think the damage is already done especially in the backdrop of so many cases of quarantined people having escaped the isolation facilities and what not. At some point, yes, everyone with flu like symptoms will be subjected to COVID-19 testing.

Originally Posted by yd_gli

For a country with India's population, inferring any conclusions from a sample size of ~28k is a laughable proposition. Agreed that we don't have the required number of test kits, but the government putting out random statements on community transmission, infection rates going down etc based on this sample size is a risky endeavor. All it does is lure the population into a false sense of victory/security.

I totally agree with you. We may have been leaders in eradicating Small pox and Polio but its too early to say " we are doing better". We are only doing what is required at this point of time , but the true extent of burden is unknown yet. Let few weeks pass, let more tests happen to conclude anything.

Countries like Germany are justified in claiming that they are doing better. They have run tests way more than any other developed nations and the mortality rates are low as the positive cases are caught hold earlier and commenced with treatment. Germany has solid numbers to back up their claim, India does not !

Originally Posted by mvadg

Same with the advice from Dr. Fauci

Thanks for sharing this video. Dr. Fauci is spot on with his most balanced answers and thoughts . Such genuine videos need to go viral on whatsapp !! I am already forwarding it to many of them.

I am a very young doctor to be honest and am not even an infectious physician. However I am glad that senior experts like Dr. Fauci have echoed the same thought as mine when asked how is COVID-19 different and why is it a matter of concern. I had opined the same a few weeks back in this post below.

Originally Posted by vivek95

. A common man should always be more worried about a respiratory infection epidemic than anything else.

Originally Posted by ksameer1234

I am not sure how kindly would Dr. Vivek take if his medical opinion is read with that of someone who graduated in engineering and goes around as a Doctor by virtue of PhD in economics

Originally Posted by doxinboy

His article appeared in The New York Times today titled "

I would not dismiss his calculations as he is a senior epidemiology expert. Like many other scientists and doctors across the globe, his intentions seem to be genuine to caution the respective governments of the nations to prepare themselves better. Infact, I would want the Government of India to pay heed to his advises. He for surely knows what he is talking about. As I had mentioned a couple of days back on this thread, the true experts on the top of this pyramid are Epidemiologists and Microbiologists. We physicians follow their inputs more than them following ours.

However, at present on planet Earth, there is NO expert who can talk about something with utmost certainty and that is the dynamics of the virus and the possible role of environmental factors on its spread. Unless that is ascertained, mathematical models alone won't define the problem statement that India is likely to encounter.

Originally Posted by nasa_hubble

Everybody cannot be tested because, it is not possible.

Yes, its not possible to test everyone because of resource constraints. Many suspected patients referred by physicians including me are being turned away at testing centres. I would not blame the Government, they are doing the best they can. Pune based firm is talking about supplying their indigenously developed kits across the nation. Hope we get true numbers then.

--Dr. Vivek

[AZT]

Originally Posted by skdking

Just because we have cartoons running our news (cum entertainment) channels does not make BBC a paragon of virtue.

I would suggest Reuters and Bloomberg for a good analysis. BBC and Guardian are also good, reporting is still more factual than our Indian News channels. I have cut down watching Indian News channels myself, there is no accountability for wrong reporting.

Originally Posted by hserus

Epidemiology and public health are multi disciplinary fields in which you need economics and graph theory as much as you need medicine.

This man knows definitely what he's talking about. The centre for disease control (CDC) in the US uses similar experts to run their models. I hope all the haters at least take a minute to watch the video and not base their opinion on random comments.These numbers were estimates before the lock down though so we should do better now.

"Biased BBC" really? I mean we have our share of channels here that primarily subsist on noisy anchors and fake news, and the BBC of all channels, for gods sake, is being accused of bias? What is wrong with the world?

Agree. Whenever I hear this whole foreign media bashing I always ask the person what makes you think so and its always shady websites like Viral Kida News, Op India and Swarajya. These are not news outlets and should not even be treated as such.

If only more people treated their mind as they treat their bodies and avoided junk news as they avoid junk food

[carboy]

BBC is biased, New York Times is biased, Washington Post is biased, Wall Street Journal is biased. Only good sources of news are Zee News, India TV & Republic. Or maybe OpIndia or PostCard.news

[shashank.nk]

Originally Posted by vivek95

Yes, its not possible to test everyone because of resource constraints. Many suspected patients referred by physicians including me are being turned away at testing centres. --Dr. Vivek

Is this the case even with the Private Labs who have now been included ? I thought if you had flu-like symptoms and was referred by a doctor, you could simply walk-in to one to these labs, pay the charges and get a test done even if you don't have a history of foreign travel or contact with lab-tested persons.

If labs refuse testing based on symptoms but only rely on coming into contact with infected persons or foreign travel history it may not achieve much.

[SilentEngine]

Originally Posted by mvadg

Dr. Ramanan Laxminarayan should be able clear up a lot of questions that people are asking here - these are the same ones that Dr. Vivek and other doctors on this thread have answered already, but all in one place and the video is easier to watch than reading .

Same with the advice from Dr. Fauci

Thank you for the video. Some here are questioning his credentials (or may be because he was interviewed by Barkha and not the one who shall not be named), but as others have already mentioned, it requires a collective effort to deal with a pandemic. In fact, GOI has already taken one step that he suggested which was for a complete lockdown.

[indian21r]

BREAKING: United Kingdom Prime Minister Boris Johnson tests positive for COVID19

https://www.ksby.com/news/national/c...e-for-covid-19

This virus is sweeping across the world touching everyone from slums to people in power corridors