The ravaging pandemic, and thoughts on re-alignment of strategies

With a nation fighting on all fronts and yet waiting for a peak to come, little sense in calculating its timing, or altitude, as it takes away a readers’ motivation.

The key factor, between the last epidemic, where a standard regime of antibiotics was given with immense stress on HCQ (used widely, published in elite journals with un-ambiguous lessons on efficacy, now among the unmentionables). Added to that, what enhanced the response were small amounts of steroids, tapered within less than a week, under the supervision of a competent physician. What was not solved at this level was the segment that was hospitalized. The age-old chain of primary level suspicion. secondary therapy to revert the disease, and a final tertiary care environment, which generally meant pre-ventilatory, or ventilatory stage stood in place. Covid finally is an inflammatory disease—the fight between body defence mechanism and tons of replicating foreign proteins turns the consequences into a ravaged battlefield.

The present surge was predicted by epidemiologists, and promptly shared by the PM on March 17th with all state CMs. Despite that, it could not be predicted that India, sitting pretty a few months back, with excess vaccines, better controlled in % incidence, and mortality, has added 1 million cases in 3 days. The figures leave little leeway for scrutiny if one was to count back estimates from mortuaries.

The key point of distress and agony is the lack of oxygen beds and ventilators. Though oxygen is a key support of one out of three patients in any ICU, due to respiratory illness, cardiac conditions, post-surgical recuperation particularly after brain surgery, four times the load of every patient’s requirement for survival due to advanced Covid, was never postulated.

Keeping the three cardinal principles of masking……, there seems to have been no let down in numbers, weekend lockdowns, and restrictions in day time mobility.

With so many mutants, the UK variant, detected within weeks of the vaccines program launched in India, was known to spread faster, bring on symptoms, faster, but its susceptibly for excess mortality was not mentioned as a caution. Today Britain after a 2-week lift of lockdown continues to show a downward trend in infection incidence, which fell by 8%, to 2206/day. Fifty% of its population inoculated

With more confusion of variants from UK, SA, Brazil, now comes the triple variant, the “Indian variant” spotted in Israel, and later in Switzerland.

The confusion gets confounded, when a report props up, that 60% of doctors in Covid treating hospitals have the “Indian variant”. Infection in Covid treating staff is known, as there were selected as the first lot for vaccines. It requires a structured study, including other patients who have taken vaccines at the same centre, with a placebo group who visit the hospitals for other ailments to make such a statement. Besides, a diligent ICMR should tally the results with the genomic map of the Indian variant. There was no such variant after sufficient surveillance a few weeks ago.

We come to the accepted fact that the virus has so far out-smarted science. 

Besides the numbers and increased incidence, the core question is, why is there an overload of dire respiratory consequences in this surge. Is the “Indian variant “cruelly” loaded with an excessive propensity to the lungs, that too straight to the ventilatory, or oxygen support stage? That information shall come from spotting this variant and comparing it with others that have been prevalent so far. RT-PCR tests, at randomly chosen centres, may give some authentic information to rely upon. The present statement of infection of the Indian variant in hospital doctors is more likely to affect the functioning of hospital staff across the country.

A lot of handling of such an unprecedented pandemic depends on how publicizing, giving urgency to a preventive program as vaccination, is misunderstood by the people. Panic, depression, violent behaviour are the most difficult to manage if physician consultation is delayed. The basic fact is, that people are reporting late, or basic treatment at the earliest starts much later.

With the coming of “vaccines”, many misunderstood it as core therapy, rather than prevention. The introduction of antiviral drugs as Decimvir, and lack of proper cautions made people rush for the wrong counter. A patient in such a state of panic thinks of the worse and runs to the final post of protection, which is not his cure or solace. The medico-legal concerns and a patient’s constitutional will make the primary and secondary line of reasoned and effective therapy, withdraw its scientific advice. The case then lands in an advanced oxygen requirement state straight to a hospital. The primary and secondary interventions somehow are being bypassed by the patient. Health information bulletins should enforce the sequence of safety.

The golden advice is, that even with a suspected one-day fever, sore throat that the patient finds unusual, the secondary physician should take -over. At the level of personal experience, 80-90% cure rates are seen. Time is worth a hundred litres of oxygen. Campaigns may be started, that even with one day of fever, unusual throat symptoms, therapy may be started, as RT-PCR takes almost half a week. The antibiotics and mild steroids you are taking are the same as what you would have taken for a normal upper respiratory tract infection.

The reason behind early action, even before what is a delayed report is the probability of test positivity, which is in proportion to the actual prevalence of the disease, as per the Bayes’ Theorem, popular with epidemiologists. A simple example is, that a patient with signs of tuberculosis in an endemic, area, with a few negative serum tests, is more likely to show them as a false negative. A similar case in the US, where Tuberculosis incidence is < 0.01 %, showing a positive result, is highly likely to have a false positive test.

Thus, treatment applied even at one day’s symptoms can be started by a specialist. It shall restore confidence in the prevailing system, and unload traffic at the hospital. People are confused, between vaccines as a cure or prevention. Early therapy. even after a day’s symptoms should pull them through. At the ventilatory state, I wonder how much difference does oxygen, though necessary, make in mortality figures. The guard needs to be taken earlier, even as a pacer starts his run-up!

Nice to note, that despite his brilliance in all other matters, the HM is the one to advise publically, that Decimvir is not to be used for common symptoms. Leave it alone to hospital specialists to decide. That should end the unnecessary scampering and black marketing. The Delhi CM needs to have his own pullover Delhi hospitals, capitalists, industry, to install 5-6 oxygen plants, announcing or arranging soft loans instead of writing letters to other CMs. The answers some of them curt may be embarrassing. So do we expect at least two plants in the next ten days? From “AAM”, rise to “KHAAS”, for that is the virtue of strong administrators. I admire him and his love for “Dilliwalas” but his tutorials on masks, several times a day, sometimes gives a school-boyish impression. I would like to see him taking rounds daily, standing next to an oxygen generating plant. Saying for his good. A citizen has the right to have his voice heard by his CM.

Adequate steps are being taken at all levels. The government should pass a dictate, that private and government hospitals above a certain turn over the need to have dedicated oxygen- concentrating plants within ten days. That brings us close to the SC verdict, “Beg, Borrow, Steal”

The infrastructure now set up shall be the beginning of a comprehensive Indian Healthcare infrastructure.

The lockdown may come or not, but speedy vaccination, installation of oxygen concentrating plants, within weeks, and the re-assertion of the physician specialist at the earliest state, should change the picture.

“Keh do in hasraton sey kahin ur ja basein, Itni jagah nain hai dil-e-dagh-daar mein” 

-Bahadur Shah Zafar

(Tell these ambitions and desires to settle somewhere else, there is not enough space for them in this traumatized heart)




Views expressed above are the author’s own.


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