“Toilet Paper Na Milega Dobara,” writes Sheetal Gokhale as a rehashed title to a Bollywood film. Then quickly types “Doh Toilet Paper Bahrah Hanth”. On a Saturday morning the Saratoga dentist is playing a game of adding toilet paper to names of Bollywood films. Her WhatsApp group is in giggles. Nina Daruwalla, the realtor who has been collecting shoe covers to donate to Santa Clara nurses and staff, joins in, “Gumnam Toilet Paper”.
The entries come in fast and furious: Mein Toilet Paper Tere Angan Ke; Dilwale Toilet Paper Le Jayenge; Kagaz Ke Toilet Paper; Maine Toilet Paper Se Pyaar Kiya; Hum Toilet Paper De Chuke Sanam; Jis Desh Main Toilet Paper Bhathi Hai; Pati Patni Aur Toilet Paper.
Toilet Paper Hunting, Toilet Paper Wars, the gaffes continue. It is like a valve has been released and the overstressed brain has come up for air.
The nurses of Santa Clara have requested for some supplies. The ladies used to receiving wishlists from teachers at the start of every school year are now pooling resources to meet this request. Tailoring of masks is starting in earnest. Patterns and sewing instructions are exchanged, sewing machines borrowed and the ladies are off to a running start. All hands on deck. It is when stress creates a yoyo of emotions and whatsapp messages roller coaster through the phones that equanimity is most desired.
Salil Jain, a Cupertino resident unrolls his mat. He has been doing yoga at home with his own private yoga teacher out of India. myYogaTeacher, a Silicon Valley based fitness startup, offers its customers private 1-on-1 yoga sessions online. “For a fixed sum I can do unlimited hours. I plan to do two hour sessions three times a week,” says Salil as he shutters himself in his office. He is signing up for a session by selecting a teacher from their profile and their introduction videos.
Rajiv brews his fourth cup of tea for the day and clicks on the website. In response to the Coronavirus Pandemic, myYogaTeacher has launched live online group classes to help those practicing social distancing. To support our communities and our health these classes are completely free says the CEO Jitendra Gupta.
“For others not so motivated myYogaTeacher not only guides but more importantly will make sure that you are showing up and practicing,” says Rajiv to his wife Ritu. He decides to sign her up. She purrs and pours herself a gin and tonic and heads to the study to join a zoom book club meeting. Reading soothes her nerves.
In homes across the Bay, members of her book club are downloading zoom for the first time. They struggle with getting their audio and videos working and soon their first zoom book club meeting is off to a good start albeit minus two members who couldn’t join in despite their best efforts. As they munch on ideas and thoughts the ladies who usually lunch together discuss Amitav Ghosh’s latest book The Gun Island while sipping their gin and tonics. After all Chloroquine the malaria drug of the colonists is being bandied about as the new cure for Corona.
A Bay Area group comprising of 6 couples has decided to have dinner together via a Facebook meeting on Saturday at 7pm. Everyone will join in virtually for Gupshup and Quaratini or now Chat and Gin-chloroquine.
Long walks are becoming part of the new routine. Like students on a silence meditation course the walkers avert their eyes as they pass each other in the park.
Brown yanks at his leash. His routine has not been disrupted by Corona. After finishing his breakfast of poached eggs and dog food he is ready for his walk. With a jaunty step he heads out of the closed door out towards McClellan Park where other dogs are walking their owners. It is business as usual for him. He passes the CEO of myYogaTeacher, a bay area resident and gives him a wag of his tail. No sniffing of the butts in the days of social distancing thinks Brown as he dutifully averts his eyes from his buddy Froddo.
Building mental immunity is as important as building immunity of the body to deal with stress.
Ritu Marwah is washing her hands hourly. She agrees with “Better Saaf than Sorry”. Her husband and dog feel she could do better on the walking and yoga fronts.
Close down group meals for seniors. Cancel social gatherings.
The directive, from the Illinois Department on Aging, sent shock waves through senior service organizations late last week.
Overnight, Area Agencies on Aging had to figure out how to help people in their homes instead of at sites where they mingle and get various types of assistance.
This is the new reality as the COVID-19 virus barrels into communities across America. Older adults — the demographic group most at risk of dying if they become ill ― are being warned against going out and risking contagion. And programs that serve this population are struggling to ensure that seniors who live in the community, especially those who are sick and frail, aren’t neglected.
This vulnerable population far outstrips a group that has received more attention: older adults in nursing homes. In the U.S., only 1.4 million seniors reside in these institutions; by contrast, about 47 million older adults are aging in place. An additional 812,000 seniors make their homes at assisted living facilities.
While some of these seniors are relatively healthy, a significant portion of them are not. Outside of nursing homes, 15% of America’s 65-and-older population (more than 7 million seniors) is frail, a condition that greatly reduces their ability to cope with even minor medical setbacks. Sixty percent have at least two chronic conditions, such as heart disease, lung disease or diabetes, that raise the chance that the coronavirus could kill them.
But the virus is far from the only threat older adults face. The specter of hunger and malnutrition looms, as sites serving group meals shut down and seniors are unable or afraid to go out and shop for groceries. An estimated 5.5 million older adults were considered “food insecure” — without consistent access to sufficient healthy food ― even before this crisis.
As the health care system becomes preoccupied with the new coronavirus, non-urgent doctors’ visits are being canceled. Older adults who otherwise might have had chronic illness checkups may now deteriorate at home, unnoticed. If they don’t go out, their mobility could become compromised — a risk for decline.
Furthermore, if older adults stop seeing people regularly, isolation and loneliness could set in, generating stress and undermining their ability to cope. And if paid companions and home health aides become ill, quarantined or unable to work because they need to care for children whose schools have closed, older adults could be left without needed care.
Yet government agencies have not issued detailed guidance about how to protect these at-risk seniors amid the threat of the COVID-19 virus.
“I’m very disappointed and surprised at the lack of focus by the CDC in specifically addressing the needs of these high-risk patients,” said Dr. Carla Perissinotto, associate chief for geriatrics clinical programs at the University of California-San Francisco, referring to the Centers for Disease Control and Protection.
In this vacuum, programs that serve vulnerable seniors are scrambling to adjust and minimize potential damage.
Meals on Wheels America CEO Ellie Hollander said “we have grave concerns” as senior centers and group dining sites serving hot meals to millions of at-risk older adults close. “The demand for home-delivered meals is going to increase exponentially,” she predicted.
That presents a host of challenges. How will transportation be arranged, and who will deliver the meals? About two-thirds of the volunteers that Meals on Wheels depends on are age 60 or older ― the age group now being told to limit contact with other people as much as possible.
In suburban Cook County just outside Chicago, AgeOptions, an Area Agency on Aging that serves 172,000 older adults, on Thursday shuttered 36 dining sites, 21 memory cafes for people with dementia and their caregivers, and programs at 30 libraries after the Illinois Department on Aging recommended that all such gatherings be suspended.
Older adults who depend on a hot breakfast, lunch or dinner “were met at their cars with packaged meals” and sent home instead of having a chance to sit with friends and socialize, said Diane Slezak, AgeOptions president. The agency is scrambling to figure out how to provide meals for pickup or bring them to people’s homes.
With Mather, another Illinois organization focused on seniors, AgeOptions plans to expand “Telephone Topics” — a call-in program featuring group discussions, lectures, meditation classes and live performances — for seniors now confined at home and at risk of social isolation.
In New York City, Mount Sinai at Home every day serves about 1,200 older adults who are homebound with serious illnesses and disabilities — an extraordinarily vulnerable group. A major concern is what will happen to clients if home care workers become sick with the coronavirus, are quarantined or are unable to show up for work because they have to care for family members, said Dr. Linda DeCherrie, Mount Sinai at Home’s clinical director and a professor of geriatrics at Mount Sinai Health System.
With that in mind, DeCherrie and her colleagues are checking with every patient on the program’s roster, evaluating how much help the person is getting and asking whether they know someone ― a son or daughter, a friend, a neighbor — who could step in if aides become unavailable. “We want to have those names and contact information ready,” she said.
If caregivers aren’t available, these frail, homebound patients could deteriorate rapidly. “We don’t want to take them to the hospital, if at all possible,” DeCherrie said. “The hospitals are going to be full and we don’t want to expose them to that environment.”
In San Francisco, UCSF’s Care at Home program serves about 400 similarly vulnerable older adults. “Testing [for the coronavirus] is even more of a problem for people who are homebound,” said Perissinotto, who oversees the program. And adequate protective equipment ― gloves, gowns, masks, eye shields — is extremely difficult to find for home-based providers, Perissinotto said, a concern voiced by other experts as well.
To the extent possible, UCSF program staff are trying to do video visits so they can assess whether patients are symptomatic ― feverish or coughing — before going out to their homes. But some patients don’t have the technology that makes that possible or aren’t comfortable using it. And others, with cognitive impairments who don’t have family at home, may not be able to respond appropriately.
At UCSF’s general medicine clinic, nonessential medical visits have been canceled. “I have a lot of older patients with chronic pain or diabetes who otherwise would come in for three-month visits,” said Dr. Anna Chodos, a geriatrician and assistant professor of medicine who practices in the clinic. “Now, I’m talking to them over the phone.”
“I’m less worried about people who can answer the phone and report on what they’re doing,” she said. “But I have a lot of older patients who are living alone with mild dementia, serious hearing issues and mobility impairments who can’t work their phones.”
Plans to and from India get made a year in advance and are being affected by the COVID-19 pandemic. The Embassy of India in D.C. has released information on Visa restrictions for those traveling to and from India during the travels ban, along with phone numbers that can be called for more detailed information. Ensure that you are prepared for your next steps as the travel ban is enforced!
For those trying to travel to and from India, read closely about your visa status.
If you have further questions and would like to speak to a representative, there are 24 hour helplines available.
For more information about India closing its borders, check out our previous article here.
Srishti Prabha is the current Assistant Editor at India Currents and has worked in low income/affordable housing as an advocate for women and people of color. She is passionate about diversifying spaces, preserving culture, and removing barriers to equity.
I sipped my morning coffee and browsed through the news, social media and emails. Spain declared an emergency and locked down. The situation was still dire in Italy. Testing was woefully inadequate in the US and published numbers were the tip of the iceberg. Toilet paper, cleaning supplies and frozen food shelves could not be restocked fast enough in supermarkets and grocery stores across the country to keep up with the wave of panic buying.
Three other items caught my eye.
The Times had a heartwarming story about how Italians nationwide – under lockdown to prevent the spread of the coronavirus – took to singing and playing musical instruments from their balconies and rooftops, with “piano chords, trumpet blasts, violin serenades and even the clanging of pots and pans” spilling from people’s homes” to show that they would get past this together, and to thank all the medical personnel on the front lines fighting the spread of the virus.
A good friend in Switzerland sent me a WhatsApp message. “People have been hoarding toilet paper here,” she said, “empty shelves.” She also forwarded a video (it likely took multiple forwards to get to me) showing a young man in a coffee shop paying for his coffee with single sheets of toilet paper, and the barista asking for one more sheet, as Abba’s classic song plays in the background. Money, money, money, must be funny, in the rich man’s world.
And then I saw this post on the social networking platform for local communities, Nextdoor:
“I’d like to take a moment to reflect on our current situation by bringing up a quote from the author C.S. Lewis. It’s from an essay titled “On Living in an Atomic Age”. I’ll let Lewis say what he says best:
‘In one way we think a great deal too much of the atomic bomb. “How are we to live in an atomic age?” I am tempted to reply: “Why, as you would have lived in the sixteenth century when the plague visited London almost every year, or as you would have lived in a Viking age when raiders from Scandinavia might land and cut your throat any night; or indeed, as you are already living in an age of cancer, an age of syphilis, an age of paralysis, an age of air raids, an age of railway accidents, an age of motor accidents.”
In other words, do not let us begin by exaggerating the novelty of our situation…
This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds.’
Lewis wrote these words 72 years ago. We must heed his advice today. Let’s not panic. Let’s be sensible. Let’s use common sense. Let’s adopt common courtesy. Let’s pull together towards a common cause.
Carefully follow the simple, sensible advice of healthcare professionals. Wash your hands, Maintain social distance. Stay indoors and avoid contact with others as much as you can. Be prepared to sacrifice some of your needs for the common good. It’s not just for you. It’s for everyone around you, and for everyone around them.
Together, we will eventually emerge victorious from the “Age of the Coronavirus.”
Mukund Acharya is a co-founder ofSukham,an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community.
With gratitude to Joel Filipe for the use of his beautiful photograph from Unsplash.com
The recommendations of the Committee of Secretaries chaired by Chairpersonship of Dr. Harsh Vardhan, Union Minister of Health &Family Welfare. Sh. Hardeep S. Puri, Minister of Civil Aviation, Dr. S. Jaishankar, Minister of External Affairs, Sh. Nityananda Rai, Minister of State for Home, Shri Mansukh Mandaviya, Minister of State (I/c), Ministry of Shipping, Chemicals and Fertilisers and Sh. Ashwini Kumar Choubey, Minister of State, Health &Family Welfare were placed before Group of Ministers. After detailed deliberations on preventive measures, actions taken and preparedness for Novel Coronavirus Disease (COVID-19), the GoM took the following decisions:
All existing visas, except diplomatic, official, UN/International Organizations, employment, project
visas, stand suspended till 15th April 2020. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
Visa free travel facility granted to OCI card holders is kept in abeyance till April 15th 2020. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
Any foreign national who intends to travel to India for compelling reason may contact the nearest Indian Mission.
All incoming travellers, including Indian nationals, arriving from or having visited China, Italy, Iran, Republic of Korea, France, Spain and Germany after 15th February, 2020 shall be quarantined for a minimum period of 14 days. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
Incoming travellers, including Indian nationals, are advised to avoid non-essential travel and are informed that they can be quarantined for a minimum of 14 days on their arrival in India.
Indian nationals are strongly advised to avoid all non-essential travel abroad. On their return, they can be subjected to quarantine for a minimum of 14 days.
International traffic through land borders will be restricted to Designated check posts with robust screening facilities. These will be notified separately by M/o Home Affairs.
Provision for testing primarily for students/compassionate cases in Italy to be made and collection for samples to be organized accordingly. Those tested negative will be allowed to travel and will be quarantined on arrival in India for 14 days.
Originally Posted On: 11 MAR 2020 10:18PM by PIB Delhi
Long before the novel coronavirus made its surprise appearance, the nation’s nursing homes were struggling to obey basic infection prevention protocols designed to halt the spread of viruses and bacteria they battle daily.
Since the beginning of 2017, government health inspectors have cited more nursing homes for failing to ensure that all workers follow those prevention and control rules than for any other type of violation, according to a Kaiser Health News analysis of federal records.
In all, 9,372 nursing homes, or 61%, were cited for one or more infection-control deficiencies, the analysis showed. It also found violations were more common at homes with fewer nurses and aides than at facilities with higher staffing levels.
Even among nursing homes crowned with the maximum government rating of five stars for overall quality, 4 in 10 have been cited for an infection-control lapse. Those include the Life Care Center of Kirkland, Washington, a Seattle suburb, where five people who had lived at the facility have died.
Inspection reports from around the country show many errors are rudimentary, such as workers not washing their hands as they moved to the next patient, or failing to don masks, gloves and gowns when in the rooms of contagious patients in isolation.
“It’s all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak,” said Patricia Hunter, the Washington State Long-Term Care Ombuds, who addresses complaints from residents and families and pushes for improvements in facilities.
In recent years, the federal government has been ramping up the standards for nursing homes, but inspectors remain frustrated by the prevalence of sloppy or nonexistent handwashing. “We have got to do better on handwashing,” Evan Shulman, the director for the nursing home division of the Centers for Medicare & Medicaid Services, told an association of nursing home directors in 2018.
While citations are rampant across the industry, health inspectors have classified all but 1% of violations as minor and not warranting fines, the KHN analysis found. A single low-level citation usually has limited impact on the overall star rating, the only metric most consumers examine.
The coronavirus has demonstrated its potential lethality among the old and frail in Kirkland, but the infections that nursing homes already battle with mixed success — influenza and antibiotic-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA) — can be equally fatal. As many as 3.8 million infections occur in nursing homes each year, killing nearly 388,000 residents.
Dr. David Gifford, the chief medical officer for the American Health Care Association, the primary nursing home trade group, told reporters Monday that these facilities were ready to deal with coronavirus infections through the prevention plans they have in place. “We prepare for seasonal influenza every year — it’s very similar to that,” he said.
“We are reinforcing the information for basic procedures for how to prevent the spread,” he added, such as keeping infected residents away from others and having sick employees stay home.
Yet the same industry deficits that have hampered past infection-control efforts are in play with the coronavirus. Nursing homes experience frequent staff turnover, and new or temporary workers are less likely to be familiar with a facility’s protocols. Also, inspectors have found that these homes have had difficulty making sure that potentially infected workers stay home, a problem compounded by the low pay and limited time-off benefits many receive.
During a norovirus outbreak in 2017 at another Washington state nursing home, for instance, at least six infected employees returned to work earlier than they were supposed to. Inspectors discovered the virus ultimately spread to 32 employees and 43 residents — more than 40% of those living in the home, according to an inspection report.
Even if nursing homes are successful in getting infected workers to take days off, they may run into trouble finding replacements. Dr. David Nace, director of long-term care and flu programs at the University of Pittsburgh Department of Medicine, said staffing issues are compounded by a national shortage of healthcare workers. “Facilities may be faced with the issue of closure if they don’t have the staffing,” he said.
KHN’s analysis found that 53% of homes with the most nurses and aides — which CMS awards five stars for staffing on its Nursing Home Compare website — had been cited for infection-control violations in the past three years, while 65% of homes with the fewest staff — garnering only one star — were cited for the same type of failing. The staffing stars make up one component of the overall rating.
“So many times, when there aren’t enough staff, the aides and nurses are literally trying to do 50 things at once, running from person to person,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, a nonprofit based in Washington, D.C. “That’s when things fall through the cracks, like handwashing, which is the most useful thing to do to prevent infections.”
More sparsely staffed nursing homes were also cited more often: one-star facilities averaged 1.5 deficiencies while five-star facilities averaged 1.3 deficiencies. But out of more than 13,000 citations for infection-control lapses, regulators classified only 109 as serious harms or threats to patients. That finding echoed the results of a similar investigation KHN conducted in 2017. “It shows how ineffectual the enforcement situation is,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy.
One such violation was cited last April at the Kirkland nursing home after inspectors there observed a registered nurse treating a patient whose feet were touching the floor, even though one heel had a pressure sore that the resident’s daughter said she feared was infected. “It was unhygienic,” the daughter told inspectors.
Inspectors also watched another nursing home employee work in the room of a patient with pneumonia without wearing a mask, gown and gloves as required by a sign outside the room. They noted in their report that the facility had experienced two outbreaks of influenza that year, affecting at least 17 residents and seven staff members all told. Inspectors labeled the violations they observed as low level because they caused “minimal harm or potential for actual harm.” The nursing home pledged to reeducate staff on procedures and investigators found no problems when they revisited two months later.
Life Care Center, in an upscale, wooded neighborhood less than a mile from Lake Washington’s popular Juanita Beach Park, said in a statement released Monday that it is screening workers before they start work and after and has suspended visits and new admissions.
“We are also following infection control recommendations, including proper hand-washing techniques and wearing masks, gowns and gloves when caring for any symptomatic patients,” the statement said. The facility declined to discuss its previous citation.
Seema Verma, the CMS administrator, said during a press briefing at the White House Tuesday night that her agency is sending inspectors to the nursing home, as well as a hospital and dialysis center that treated coronavirus patients, to see if federal health and safety regulations were followed.
Hunter, the Washington state ombud, said that during her recent visits to 14 nursing homes in three Northwestern states, she observed that aides were generally good about using hand sanitizer but rarely washed residents’ hands. Not every resident room had a sink, she said. “I haven’t seen one resident have their hands washed during lunchtime or dinnertime,” she said.
While some nursing homes are making concerted efforts, “there are nursing homes that are really dirty and there are concerns that they’re not getting the job done,” Hunter added.” The trouble is when you don’t have enough workers, or you don’t have a stable workforce that’s trained to follow your protocol, that’s a weakness in the system.”
In 2016, CMS updated and expanded its infection-control rules, requiring among other things that each facility appoint one person to be in charge of infection control. CMS required the employee in that position, known as an infection preventionist, to complete specialized training and work at the facility either part time or full time. The Trump administration has proposed eliminating the on-site requirement.
Instead, CMS proposed the preventionist be someone who has spent “sufficient time” at the facility to oversee its infection-control efforts. It has asked the public for advice on how to define sufficient.
“We believe this is an appropriate standard,” the agency wrote in its proposed rule, issued last July. “However, we are also concerned that there could be a substantial variance in how LTC [long-term care] facilities interpret this requirement.”
KHN senior correspondent JoNel Aleccia contributed to this report.