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    • Friday 28 May 2021

    Managing the Covid

    Managing the Covid

    Ashutosh kumar May 28, 2021

      Managing the Covid


      Covid is an insidious enemy.in March 2021 it knocked us again when we thought that we concurred our invisible enemy. Within a month, load of active cases had gone to 6 lacs ten thousand from one lakh sixty five thousand. This figure can establish the enormity of our enemy. Why did it spread so fast? From top policy makers to the normal public all became complacent. We shunned our covid appropriate behavior. Covid spread was so exponential that by 23rd of May our confirmed cases tally reached to 267 million. India reached another grim landmark and became second most affected country by active cases, total cases and third by death. Though India`s CFR(Case fatality rate) 1.12 % is among the lowest but still it will be pertinent to highlight that it took just 27 days to add last 1 lakh death. India is now accounts for 19.08% of all active cases globally and 8.33% of all deaths globally. It shows how much stress was there on our health infrastructure. In some cities we reached the stage where hospital had to take extreme step of discharging asymptomatic at the earliest so that more serious patient can occupy the beds. Same strategy was adopted for ICU as well. Drugs like remdesivir and other steroids suddenly became out of stock. The sudden spike of the cases is the cumulative result of lack of Covid appropriate behavior, different mutants of virus, casual approach from govt and lack of vaccination. How can we handle disease`s progression and its clinical management? Health infrastructure is pathetic across the country. From one lab before pandemic to 2500 plus lab today and still during the peak of the pandemic labs couldn’t fulfill the demand. Production capacity of liquid medical oxygen has been enhanced to 700 MT per day at pre pandemic period to 9000 MT per day today but still hospitals were short of oxygen. Same story is with hospital beds, medical staff, and equipment and so on so forth. We all know that disease is very infectious and we can’t match its speed with our infrastructure. Let us face this reality and we should work around it. Since long to tackle the Covid government of India emphasize on Test, trace, treat, Public compliance and vaccinate. After all this emphasize still we are facing the second wave and experts are predicting for 3rd wave as well. Is the strategy wrong? Answer is no. Problem is with the implementation. Holistic approach for health infra and robust system needs to be placed to tackle the pandemic. Instead of chasing the virus we need to be few steps ahead from it. Let us examine the each of the strategy and find out how we can succeed. 1) Test Right now we are testing in less numbers. Although we have ramped up lab infrastructure across the country .Till today we have tested 33cr people but still this number is less due to the size of the population. We need to deploy the technology for mass testing. Whole methodology for testing needs to be changed. We need to deploy mobile bans, testing booths in schools, community centers and RWA offices. People need not to travel beyond a point for test. Team of community health workers, Asha workers, RWA team needs to be formed who will survey each home and keep tracking their respective area and as per the established protocol they will encourage people for getting them tested and dedicated team can collect the sample at home. Testing centers collecting the sample should generate unique number which will comprises individual detail date and time. This unique number will be referred during whole tracing or treatment protocol. Please note if we won’t test adequately then even moderate infection can lead to severe complications. So expansion of testing base and infrastructure is the key. We should do this in a mission mode. 2) Trace Traceability is another factor which implementation needs to be reviewed. We need to make evidence based data base for contract tracing. When it comes to the traceability due to the load of the case we choose to ignore this aspect of pandemic. Please understand people whom we are not tracing today, tomorrow they might come to us as mild/moderate cases and even we might find him in a hospital or in ICU. So its better that we should create robust infrastructure for contact tracing. This exercise should start when person tests positive and whoever has come in the contact of a person needs to be traced and handled as pre defined established protocol. All the exercise needs to be captured in handheld device/mobile app which is syncing the data at real time with local command/control center. Effective tracing will always keep positivity rate low. So after testing, tracing is the second most important pillar in defeating the Covid. 3) Treat As far as Covid treatment is concern, First step should be the effective communication with the patient. During the peak of pandemic I used to receive hundreds of calls for hospital bed, oxygen ,medicine. After discussing in detail with the patient`s relative it was found that actually this was a case of home isolation but as a precautionary major they have started searching the oxygen and beds. This is a panic situation. If every patient will start searching for bed and oxygen you make any kind of health infra it is bound to fail. So effective communication with patient should be the important part of treatment protocol. We need to communicate them that average recovery rate of Covid is more than 87%.There are states, where recovery rate of the patient is even 95%.We need to communicate them that if situation arises oxygen or hospital beds are amply available and they will be provided. In the back end command center should keep tracking the patients and supporting them suitably as per the established protocol and all needs to be transparently displayed in the app or information should be available through IVR. In Covid treatment first phase can be home isolation .Doctors should be available 24X7 for tele- consultation. In case of home isolation, home isolation kit should be provided by local treating team. That isolation kit should comprise Pulse oximeter, thermometer, necessary medicine as per the local treating doctor. Medication detail in the set format preferably through mobile should be stored in district command center so that treating doctor or other senior doctors should keep monitoring the patient in real time situation. Since in Covid control isolation or distancing is the key so If required doctors should check the patient and maximum necessary tests needs to be completed at door step. In the case of Covid treatment we will have to change whole thinking. Normal practice is patient go to the doctor or to the hospital but in this case we will have to bring all the medical facilities to the patient door step or nearest Covid care center If team of doctors monitoring the data of patient in a specific cluster (cluster can be a group of panchayat or wards depending upon the convenience of a particular geography) find that a particular patient in home isolation/community isolation needs hospitalization then they should immediately pass on the detail to the next team who are taking care the hospitalization. From here that team should take over the management of the patient. If positivity rate is increasing in a particular geography then to reduce the positivity rate micro contentment zone needs to be formed.. 4) Public Compliance It is high time that general public should go beyond the compliance and I would say It is time for participation not just a compliance. They need to actively involve themselves in managing the pandemic. It is not a choice but compulsion now. We have found that during the peak of second wave near absence of governance and political leadership. If I would say that they are incompetent or they don’t want to work then it would be injustice to the 20-30 % of political class who are working day in day out and trying to make the difference. But I would certainly say that problem is so huge that without public cooperation we can’t fight this Covid. Public compliance or participation is expected in Covid appropriate behavior like social distancing, wearing a face mask. Apart from that people should involve themselves in managing contentment zone, non medical work of isolation centers, vaccination centers. Idea may look absurd but we need to understand that medical staffs, police are over worked. They are working in very stress so in this hour of crisis we need to become an example and share their work load in whatever little way we can. 5) Vaccinate As per the expert, vaccination is the key. We need to expedite the vaccination. Right now our avg vaccination is 25 lacs per day if we continue the vaccinate in this speed then to cover 50% of our population we may require at least 2 years. This scenario is certainly not desirable. Pharma companies have assured that they will increase the supply by June-July. To expedite the vaccination we need to negotiate with world leaders for technology transfer and need to allow foreign vaccines to start the production here. Govt is assuring that it will vaccinate all the population by December 21.It will be certainly a great feat. As far as vaccination strategy is concerned we need to use the school network, residential colonies and try to keep hospitals out from this drive as they are already over worked. Till the time our vax doesn’t match the demand we should certainly prioritize the vaccination. Doctors, para medical staffs front line workers should be prioritized. They are working in most challenging environment. In this second wave we have lost many bright doctors. We need to avoid this situation and should try to protect them first. In short, to manage the Covid we need the support of technology, General public, vaccine and proactive government. Everyone will have to work as a team to conquer the enemy.


      Covid is an insidious enemy.in March 2021 it knocked us again when we thought that we concurred our invisible enemy. Within a month, load of active cases had gone to 6 lacs ten thousand from one lakh sixty five thousand. This figure can establish the enormity of our enemy. Why did it spread so fast? From top policy makers to the normal public all became complacent. We shunned our covid appropriate behavior. Covid spread was so exponential that by 23rd of May our confirmed cases tally reached to 267 million. India reached another grim landmark and became second most affected country by active cases, total cases  and  third by death. Though India`s CFR(Case fatality rate) 1.12 % is among the lowest but still it will be pertinent to highlight that it took just 27 days to add last 1 lakh death. India is now accounts for 19.08% of all active cases globally and 8.33% of all deaths globally. It shows how much stress was there on our health infrastructure. In some cities we reached the stage where hospital had to take extreme step of discharging asymptomatic at the earliest so that more serious patient can occupy the beds. Same strategy was adopted for ICU as well. Drugs like remdesivir and other steroids suddenly became out of stock. The sudden spike of the cases is the cumulative result of lack of Covid appropriate behavior, different mutants of virus, casual approach from govt and lack of vaccination.

      How can we handle disease`s progression and its clinical management? Health infrastructure is pathetic across the country. From one lab before pandemic to 2500 plus lab today and still during the peak of the pandemic labs couldn’t fulfill the demand. Production capacity of liquid medical oxygen has been enhanced to 700 MT per day at pre pandemic period to 9000 MT per day today but still hospitals were short of oxygen. Same story is with hospital beds, medical staff, and equipment and so on so forth. We all know that disease is very infectious and we can’t match its speed with our infrastructure. Let us face this reality and we should work around it. Since long to tackle the Covid government of India emphasize on Test, trace, treat, Public compliance and vaccinate. After all this emphasize still we are facing the second wave and experts are predicting for 3rd wave as well. Is the strategy wrong? Answer is no. Problem is with the implementation. Holistic approach for health infra and robust system needs to be placed to tackle the pandemic. Instead of chasing the virus we need to be few steps ahead from it.

       Let us examine the each of the strategy and find out how we can succeed.

      Test

       Right now we are testing in less numbers. Although we have ramped up lab infrastructure across the country .Till today we have tested 33cr people but still this number is less due to the size of the population. We need to deploy the technology for mass testing. Whole methodology for testing needs to be changed. We need to deploy mobile bans, testing booths in schools, community centers and RWA offices. People need not to travel beyond a point for test. Team of community health workers, Asha workers, RWA team needs to be formed who will survey each home and keep tracking their respective area and as per the established protocol they will encourage people for getting them tested and dedicated team can collect the sample at home. Testing centers collecting the sample should   generate unique number which will comprises individual detail date and time. This unique number will be referred during whole tracing or treatment protocol. Please note if we won’t test adequately   then even moderate infection can lead to severe complications. So expansion of testing base and infrastructure is the key. We should  do this in a mission mode.

      Trace

      Traceability is another factor which implementation needs to be reviewed. We need to make evidence based data base for contract tracing. When it comes to the traceability due to the  load of the case we choose to ignore this aspect of pandemic. Please understand people whom we are not tracing today, tomorrow they might come to us as mild/moderate cases and even we might find him in a hospital or in ICU. So its better that we should create robust infrastructure for contact tracing. This exercise should start when person tests positive and whoever has come in the contact of a person needs to be traced and handled as pre defined established protocol. All the exercise needs to be captured in handheld device/mobile app which is syncing the data at real time with local command/control center. Effective tracing will always keep positivity rate low. So after testing, tracing is the second most important pillar in defeating the Covid.

      Treat

      As far as Covid treatment is concern, First step should be the effective communication with the patient. During the peak of pandemic I used to receive hundreds of calls for hospital bed, oxygen ,medicine. After discussing in detail with the patient`s relative it was found that actually this was a case of home isolation but as a precautionary major they have started searching the oxygen and beds. This is a panic situation. If every patient will start searching for bed and oxygen you make any kind of health infra it is bound to fail. So effective communication with patient should be the important part of treatment protocol. We need to communicate them that average recovery rate of Covid is more than 87%.There are states, where recovery rate of the patient  is even 95%.We need to communicate them that if situation arises oxygen or hospital beds are amply available and they will be provided. In the back end command center should keep tracking the patients and supporting them suitably as per the established protocol and all needs to be transparently displayed in the app or information should be available through IVR.

      In Covid treatment first phase can be home isolation .Doctors should be available 24X7 for tele- consultation. In case of home isolation, home isolation kit should be provided by local treating team. That isolation kit should comprise Pulse oximeter, thermometer, necessary medicine as per the local treating doctor. Medication detail in the set format preferably through  mobile  should be stored in  district command center  so that treating doctor or other senior doctors should keep monitoring the patient in real time situation. Since in Covid control isolation or distancing is the key so If required doctors should check the patient and maximum necessary tests needs to be completed at  door step.  In the case of Covid treatment we will have to change whole thinking. Normal practice is patient go to the doctor or to the hospital but in this case we will have to bring all the medical facilities to the patient door step or nearest Covid care center

       If team of doctors monitoring the data of patient in a specific cluster (cluster can be a group of panchayat or wards depending upon the convenience of a particular geography) find that a particular patient in home isolation/community isolation needs hospitalization then they should immediately pass on the detail to the next team who are taking care the hospitalization. From here that team should take over the management of the patient. If positivity rate is increasing in a particular geography then to reduce the positivity rate micro contentment zone needs to be formed..

      Public Compliance

      It is high time that general public should go beyond the  compliance and I would say It is time for participation not just a compliance. They need to actively involve themselves in managing the pandemic. It is not a choice but compulsion now. We have found that during the peak of second wave near absence of governance and political leadership. If I would say that they are incompetent or they don’t want to work then it would be injustice to the 20-30 % of political class who are working day in day out and trying to make the difference. But I would certainly say that problem is so huge that without public cooperation we can’t fight this Covid. Public compliance or participation is expected in Covid appropriate behavior like social distancing, wearing a face mask. Apart from that people should involve themselves in managing contentment zone, non medical work of isolation centers, vaccination centers. Idea may look absurd but we need to understand that medical staffs, police are over worked. They are working in very stress so in this hour of crisis we need to become an example and share their work load in whatever little way we can.

      Vaccinate

      As per the expert, vaccination is the key. We need to expedite the vaccination. Right now our avg vaccination is 25 lacs per day if we continue the vaccinate in this speed then to cover 50% of our population  we may require at least 2 years. This scenario is certainly not desirable. Pharma companies have assured that they will increase the supply by June-July. To expedite the vaccination we need to negotiate with world leaders for technology transfer and need to allow foreign vaccines to start the production here. Govt is assuring that it will vaccinate all the population by December 21.It will be certainly a great feat. As far as vaccination strategy is concerned we need to use the school network, residential colonies and try to keep hospitals out from this drive as they are already over worked. Till the time our vax doesn’t match the demand we should certainly prioritize the vaccination. Doctors, para medical staffs front line workers should be prioritized. They are working in most challenging environment. In this second wave we have lost many bright doctors. We need to avoid this situation and should try to protect them first.

      In short, to manage the Covid we need the support of technology, General public, vaccine and proactive government. Everyone will have to work as a team to conquer the enemy.


      You can also visit:

      How to get the financial assistance for Covid affected families?


      If you are interested in getting more information on this then you may join our WhatsApp group

      https://chat.whatsapp.com/LMIt9v8J9pILlusAOhb8cG
      Read More

      Saturday 15 May 2021

      Covid -19 crisis is an opportunity

      Covid -19 crisis is an opportunity

      Ashutosh kumar May 15, 2021

      Since Jan 2020 this pandemic is testing human capabilities. It is wreaking havoc all over the world. World over lockdown has been imposed. Military has been called. Job, businesses, human life have lost. There is a blind race in the world to grab maximum vaccine. Every media is discussing, deliberating the covid. More or less no other pandemic has taken so much space in the media in govt briefing than this covid. So what is next? Can we keep deliberating about this? I have a different take and would like to draw some lesson from this pandemic and considering this disaster as an opportunity for future. Since ages we are exploiting the nature for our greed. Everyone wants more so time has come to give the pause to our greed .As per the data india stands 3rd in CO2 emissions. We need to stop this practice. Government’s world over trying hard to minimize the emission but this pandemic has given us an opportunity to expedite the whole process. When we wake up to till we go to the bed we keep fighting with the nature. We never care the nature. This pandemic has reminded us to mend our ways and start obeying to Mother Nature. We keep listening about world as one market, liberalization, world trade and so on. But when tornado of covid started moving around, all market, supply chains just collapsed. Everyone tried to secure the material in its geographical boundary. All the advocate of open market turned protectionist. Country like china tried to exploit the situation. Suddenly we started sending SOS to the whole world for medicine, raw materials, oxygen. From stocking to the distribution this pandemic started testing our limitation and we failed miserably. So we need to learn from this and need to be self reliant. It is true that for growing as a nation we need to be part of world supply chain but it is the right time to expand our capacity. Indigenous industry needs to be promoted like never before. From raw material to the final product, from production to the storage and distribution all needs to be strategize. This pandemic has taught us that we should start investing heavily in our health infrastructure. Right now our expenditure is not more than 3 % of our GDP where as US spend more than 17 of its GDP.In this pandemic our whole health infrastructure has got exposed. Our primary health couldn’t handle the rush and so people got pushed to the hospitals for reactive treatment and then they couldn’t handle the rush at normal level so people got pushed into ICU. Due to the lack of health infrastructure, normal patient got pushed to the next level and the whole system got overwhelmed. So need of the hour is to strengthen our health infrastructure. As per human development report India has 5 bed on every ten thousand people where as china has 43.Out of 167 countries we are ranked 155th on bed availability. We have just 8.6 doctors on per thousand populations. Bed availability is the key indicator to understand the health infrastructure. So we can sense that how much distance we need to cover as soon as possible. In this pandemic need of science was felt like never before. India`s national gross expenditure on research and development (GERD) is less than the 1% of GDP.It is far less than the developed countries and even less than that of some developing countries . So learning of this pandemic should be to invest heavily in R&D. When hospitals are refusing to accept the patients due to non availability of the beds, people were dying due to the lack of oxygen,all govt machineries were over stretched and almost collapsed then our civil society stood firm. Volunteers in different pockets tried helping to the needy. From arranging an oxygen to providing home cooked food it was like parallel arrangement is being made. By every passing day this got bigger and bigger. So moral of the story is we should always have faith in civil society. Whenever time has come civil societies, volunteers have come to the rescue .Their efforts needs to be acknowledged and appreciated. Darker side of the pandemic is there are people who try to exploit the situation. Unfortunately they are not a fringe element. There are many examples. People/institutions try to book profit. Due to this, cost of living/treatment gets increased exponentially. So we need to strengthen our legal system such a way that cost of living/treatment should not increase beyond a point. At last it is the time to mourn for the suffering of fellow country men.It is the time to understand the pain of medical fraternity and frontline workers.It is the time to understand that millions of people have lost the job due to the pandemic. Effects of this pandemic will be felt in years to come. So how we will understand all these suffering. We will have to start working in the direction where this kind of pandemic will be fought more effectively.

       

      Since Jan 2020 this pandemic is testing human capabilities. It is wreaking havoc all over the world. World over lockdown has been imposed. Military has been called. Job, businesses, human life have lost. There is a blind race in the world to grab maximum vaccine. Every media is discussing, deliberating the covid. More or less no other pandemic has taken so much space in the media in govt briefing than this covid.

      So what is next? Can we keep deliberating about this? I have a different take and would like to draw some lesson from this pandemic and considering this disaster as an opportunity for future.

      Since ages we are exploiting the nature for our greed. Everyone wants more so time has come to give the pause to our greed .As per the data india stands 3rd in CO2 emissions. We need to stop this practice. Government’s world over trying hard to minimize the emission but this pandemic has given us an opportunity to expedite the whole process. When we wake up to till we go to the bed we keep fighting with the nature. We never care the  nature. This pandemic has reminded us to mend our ways and start obeying to Mother Nature.

      We keep listening about world as one market, liberalization, world trade and so on. But when tornado of covid started moving around, all market, supply chains just collapsed. Everyone tried to secure the material in its geographical boundary. All the advocate of open market turned protectionist. Country like china tried to exploit the situation. Suddenly we started sending SOS to the whole world for medicine, raw materials, oxygen. From stocking to the distribution this pandemic started testing our limitation and we failed miserably. So we need to learn from this and need to be self reliant. It is true that for growing as a nation we need to be part of world supply chain but it is the right time to expand our capacity. Indigenous industry needs to be promoted like never before. From raw material to the final product, from production to the storage and distribution all needs to be strategize.

      This pandemic has taught us that we should start investing heavily in our health infrastructure. Right now our expenditure is not more than 3 % of our GDP where as US spend more than 17 of its GDP.In this pandemic our whole health infrastructure has got exposed. Our primary health couldn’t handle the rush and so people got pushed to the hospitals for reactive treatment and then they couldn’t handle the rush at normal level so people got pushed into ICU. Due to the lack of health infrastructure, normal patient got pushed to the next level and the whole system got overwhelmed. So need  of the hour is to strengthen our health infrastructure. As per human development report India has 5 bed on every ten thousand people where as china has 43.Out of 167 countries we are ranked 155th on bed availability. We have just 8.6 doctors on per thousand populations. Bed availability is the key indicator to understand the health infrastructure. So we can sense that how much distance we need to cover as soon as possible.

      In this pandemic need of science was felt like never before. India`s national gross expenditure on research and development (GERD) is less than the 1% of GDP.It is far less than the developed countries and even less than that of some developing countries .  So learning of this pandemic should be to invest heavily in R&D.

      When hospitals are refusing to accept the patients due to non availability of the beds, people were dying due to the lack of oxygen,all govt machineries were over stretched and almost collapsed then our civil society stood firm. Volunteers  in different pockets tried helping to the needy. From arranging an oxygen to providing home cooked food it was like parallel arrangement is being made. By every passing day this got bigger and bigger. So moral of the story is we should always have faith in civil society. Whenever time has come civil societies, volunteers have come to the rescue .Their efforts needs to be acknowledged and appreciated.

      Darker side of the pandemic is there are people who try to exploit the situation. Unfortunately they are not a fringe element. There are many examples. People/institutions try to book profit. Due to this, cost of living/treatment gets increased exponentially. So we need to strengthen our legal system such a way that cost of living/treatment should not increase beyond a point.

      At last it is the time to mourn for the suffering of fellow country men.It is the time to understand the pain of medical fraternity and frontline workers.It is the time to understand that millions of people have lost the job due to the pandemic. Effects of this pandemic will be felt in years to come. So how we will understand all these suffering. We will have to start working in the direction where this kind of pandemic will be fought more effectively.


      You can also visit:

      How to get the financial assistance for Covid affected families?


      If you are interested in getting more information on this then you may join our WhatsApp group

      https://chat.whatsapp.com/LMIt9v8J9pILlusAOhb8cG
      Read More
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