Tag Archives: social distancing

The Virus & The Vaccine

Getting the COVID19 vaccine out of the freezer and into people’s arms has been slow. And, even as people battle unsympathetic websites to find slots for a shot, there still are many unanswered questions.

Will people who have been vaccinated still be asymptomatic and carriers who could infect others?

Will non-vaccinated people still need to wear PPE when interacting with them?

Will the vaccine protect against two new contagious strains of the virus?

What will the Biden administration do differently in its COVID19 response?

These questions and more, were answered by experts at an Ethnic Media Services briefing on January 13.

One of the biggest concerns to the country is the slow pace of the vaccine roll out. Though the US has 20 million doses of the Pfizer & Moderna vaccine, we face innumerable challenges at both the federal and state level, in getting the vaccine out to people. Only 5 million vaccines have been distributed as of January  11th.

According to Dr. William Shaffner, Professor of Preventive Medicine and Health Policy, and Professor of Medicine in the Division of Infectious Diseases at Vanderbilt University, a number of bottle necks choked a smooth vaccine roll out. At the national level, the uncertainty in vaccine shipments put a strain on the local level. States were not sure when vaccines would arrive, sometimes delivery was delayed, or fewer doses were received than anticipated. Occasionally shipments were sent to the wrong state in error.

Dr. William Shaffer

The Pfizer Deep Freeze

A key challenge for local distribution outlets was storing the Pfizer vaccine which requires “a really deep freeze” to keep it stable and intact. So only large medical centers with appropriate freezer storage capacity and personnel trained to handle it, first received the vaccine.  Fortunately, the Moderna vaccine does not need similar storage requirements and was distributed more easily, so vulnerable populations and frontline healthcare workers in long term care facilities, nursing homes and smaller community hospitals were able to access the vaccine.

Not Just Another Flu Campaign

“Quite frankly,” said Dr. Schaffer, many facilities assumed it would be “just another flu campaign,” but they were wrong. Insufficient preparation to administer the COVID19 vaccine rather “gummed up the works.”

                      Dr. Robert Wachter

California did get the science right, added Dr. Robert M. Wachter, Professor and Chair of Medicine at UCSF, “but did not get the logistics right.” Based on the way California managed its PPE and testing protocols, he was not surprised that vaccine distribution fared poorly. It’s a complicated process which ‘would have benefitted from a thoughtful national plan’ to determine for example, how to get a vaccine from a manufacturing plant in Michigan into a Fedex box that arrives in a central Californian distribution center. Glitches occurred because states, left to devise their own distribution process, “handed off responsibility to local institutions” which improvised protocols in “the last mile” of the roll out.

The lack of national guidance allowed too much “wiggle room” for error, stated Dr. Wachter.

Health Equity Gridlock

Another problem was created by rules about which cohorts got the vaccine first in a well-meaning effort to ensure health equity and that certain groups  – frontline healthcare workers, the elderly and essential workers – were prioritized for the vaccine. But how does a “Walgreens decide if you are a pre-school teacher or a grocery store worker or someone with a pre-existing condition,” argued Dr. Wachter. Do you need a note from your doctor or employer? “I haven’t received a convincing answer from anybody.”

‘We’ll Figure It Out’ Won’t Work

The lesson to learn is that “we’ll figure it out is not going to work with COVID19,” declared Dr. Wachter. He called it ‘scandalous’ that only 30% of all vaccines distributed have been injected when “millions of people should have received the vaccine by now.”

Congress only passed a coronavirus relief bill in late December 2020, to provide supplies necessary for distributing and administering the COVID-19 vaccine.

What we have  is a “9/11 or a Pearl Harbor worth of people dying a day” when we should be treating the distribution of the vaccine as an emergency, added Dr. Wachter.

Vaccines Going to Waste

Stories about vaccines going to waste make great news stories, but that’s not the real problem, said Dr. Shaffer. The issue is that doses are sitting in refrigerators and freezers but not making it into the final phase of delivery.

At UCSF, medical, 84% of vaccines have been distributed -15 thousand of about 18 thousand doses have been injected. The worry is how doses will make their way into rural or underserved communities.

Interestingly, Dr Shaffer reported that at Vanderbilt, a survey of healthcare providers found that they were hesitant and skeptical about the vaccine before it arrived. Vanderbilt responded with a major effort to educate its staff and address concerns to reassure reluctant people and change their minds. For example, the program had to counter fears  that the vaccine is not safe for pregnant women.

Both physicians reiterated that the vaccines were safe and effective to use.

Single or Double Dose

Data from all clinical trials find that two doses are required. The first shot offers partial protection after ten days and up to 80% to 90% protected  up to the minute before getting the second dose. “The second dose boosts  you up to the ultimate number of 95% and creates more durable immunity,” confirmed Dr. Wachter.

While models show that giving more people a first shot of the vaccine will save more lives than withholding doses for the follow up shot, there are legitimate concerns about delaying the second dose – will immunity fall off, will it promote mutations by having more people partly vaccinated, or will people forget to come back for their second dose? A single dose only will not work in the long term, but deferring a second dose will get more people vaccinated sooner. So the Biden administration’s plan to get more first doses out is ‘a good strategy’ agreed Dr. Shaffer.

Will You Still Be Contagious?

Preliminary data from a Moderna study indicated that ‘a substantial proportion of people vaccinated would not be able to transmit the virus. However, until final data sounds the all clear, warned Dr. Shaffer, people should continue to observe precautions with masks and social distancing.

Biden Roll Out

The best first step for the new administration must be to lead its Covid19 response based on science and clearly communicate its national policy, emphasizing “public health and scientific principles,”  said Dr. Shaffer. They also need to address the bottlenecks in vaccine distribution and reinforce they will work together with state and local levels to troubleshoot and resolve problems. Instituting a federal policy to ensure consistency in the COVID19 response across the country will be invaluable, he added.

Challenges Ahead

There is a real risk of politically driven resistance to the vaccine especially in rural areas and persuading people that it is safe and necessary will be quite difficult, Dr. Shaffer pointed out. But as demand grows for the vaccine, websites will have to handle thousands of people going online to make appointments, and venues will have to manage large cohorts arriving for their shot. A fair system needs to be established to ensure health equity in who gets the vaccine.


Meera Kymal is the Contributing Editor at India Currents
Image by Wilfried Pohnke from Pixabay

Dharavi slum in Mumbai

India’s Low COVID Death Rate Is Puzzling

Though the COVID-19 crisis hit India hard – over 9 million cases have been reported and more than 138 thousand people have died  – the mortality rate from COVID-19 is inexplicably lower compared to other countries.

For instance, while the US leads the world with more than 14 million cases and over 276 thousand deaths, according to the John Hopkins Coronavirus Research Center, India accounts for only 10% of deaths globally and has the highest number of recovered patients of COVID-19 at 94%, even though its coronavirus caseload is second only to the US.

With such a significant share of the world’s coronavirus cases, shouldn’t COVID-19 have been more devastating in India?

Krishnaraj Rao

“Then again it has not,” announced Krishnaraj Rao, an investigative journalist from Mumbai, India, at an EMS briefing (November 20) on the pandemic.

“Something strange has been happening within the Indian subcontinent and neighboring regions,” said Rao. “For some strange reason our mortality rate per million is one eighth and our total cases seem to be in the region of one sixth per million.”

As COVID-19 began its inexorable spread across the world, the WHO recommended safety precautions to protect against the virus – physical distancing, wearing a mask, well ventilated rooms, avoiding crowds and close contact, and regularly washing hands.

But in an outcome that has puzzled epidemiologists and scientists alike, India seems to be experiencing a low mortality rate from the coronavirus, stated Rao, despite the crowded conditions in which many urban Indians live.

A large proportion of urban dwellers in a developing country like India lack access to adequate healthcare facilities and maintain poorer sanitation and hygiene practices which are known to be responsible for a higher incidence of communicable diseases.  So the virus was expected to have caused many more deaths in densely populated communities in India than it has.

Urban Indians are ‘badly housed,’ explained Rao, using Mumbai as an example to explain why crowded Indian cities offer a fertile petri-dish for catastrophic coronavirus outbreaks.  “I would say that close to 60% of the population of urban India lives closely packed together in slums.”

In a metropolis like Mumbai, home to over 20 million and India’s largest city, nearly one million people live cheek by jowl in Dharavi, one of the world’s largest slums.

“Houses are no more than two feet apart. Each house is no larger than a 10 by 12 room,” said Rao.

Each home houses about 10 to 12 people, closely packed together. It makes social distancing nearly impossible, while access to basic hygiene essentials, including toilets and hand washing are limited.

“There is only one public toilet per every two or three hundred slum dwellers,” explained Rao, highlighting the less than hygienic conditions in slums like Dharavi. “Face masks, social distancing…are close to non-existent. We take things like face masks, temperature checks and sanitizing very lightly,” he claimed.

“If it were a pandemic that was ravaging us because of a lack of social distancing,” asked Rao, why are the slums relatively less impacted than expected? And, despite overcrowding on the suburban railways, he adds, “the crisis has hit us less hard than anticipated.”

While epidemiologists attribute India’s low mortality rate to under-reporting, and even though Rao himself expected undercounting, he alleged that at least in Dharavi, there is no evidence of it. “I don’t see the bodies piling up in the streets… or the hospitals,”  nor has he noted any alarming rises in the body count.

Rao claimed he is voicing “a mainstream belief” felt across economic classes and demographics in India, that the coronavirus is not causing the high mortality rates that were anticipated.

In Dharavi, officials say that concerted public health efforts to trace, track, test and treat cases, have helped to contain community spread.

Now, recent research by Indian scientists seeking to explain why India’s death rate is so low, suggest that more Indians may be immune to COVID-19 because they live in unsanitary conditions which have created an unexpected shield from the virus.

According to one study, more than 70 percent of all COVID–19 deaths have occurred in high income countries like Italy, Spain, UK, France and USA. It hypothesized that more people died in richer countries with older populations, because better hygiene and safe sanitation practices lowered levels of immunity and made people more susceptible to the virus.

In another study scientists report, “It appears that countries with better health care, clean environment, clean food and water have higher COVID associated mortality, whereas developing and underdeveloped countries have lower mortality in terms of deaths per million population.”

Both research studies (not yet peer reviewed), suggest that in low GDP countries like India, lives of people in densely populated areas may have been saved because of poor hygiene and sanitation practices.  Unsanitary conditions and exposure to diseases from childhood may have increased their ability to ward off infections, and boosted immunity against COVID-19. Experts also suggest that the early lockdown and a younger population helped stave off a higher death toll in India.

The science is intriguing. Does greater exposure to a variety of viruses in the slums of low income countries provide a better level of protection against the coronavirus, than the overly sanitized environments of richer nations?

“Paradoxically, better sanitation leads to poor immune training and thus could be leading to higher deaths per million,” says the study. But it cautions that while the research offers a possible explanation, poor hygiene is not a solution to the pandemic.

India, and Dharavi in particular, may have pulled off a remarkable reprieve against COVID-19 for now. But the pandemic is far from over and science is still learning about this young virus. So, public health experts warn, SMS (social distance, mask, and sanitize) must remain the global mantra to keep Covid 19 at bay, until vaccines become easily available to the general public.


Meera Kymal is the contributing editor at India Currents.

photo credit: Baron Reznik

Back To The Future At School

Can schools safely reopen though the pandemic shows little sign of waning and educators stumble towards the first day of school in the absence of a clear cut strategy?

The answer is uncertain.

In early July President Trump demanded that schools “open quickly, beautifully, in the fall” for normal, in-person instruction.

The CDC responded with guidelines instructing school districts to build supportive community infrastructures to counter the onslaught of COVID-19 as schools reopened. They urged school officials to implement hygiene and social distancing practices and develop ‘proactive’ plans with health departments, parents and caregivers to deal with potential outbreaks.

A snapshot of the ‘new normal’ for K-12 schools.

Keeping active kindergartners apart; keeping their masks on; fewer students on school buses; limited class sizes; keeping staff safe; sanitizing; PPE; social distancing; online SATs; remote learning; iPads or computers for all.

For many schools, adjusting to the new normal would be a complicated and expensive endeavor.

School systems which struggled with pandemic restrictions would face even greater logistical and financial burdens meeting the new CDC requirements, leaving them with no other option than to continue with virtual classes moving forward.

President Trump tweeted his displeasure at the “very tough and expensive guidelines for opening schools,” and, under pressure, the CDC retracted its message, effectively relinquishing the decision making to school administrators. At the behest of the White House, the CDC emphasized the “importance of reopening America’s schools this fall,” and warned that extended school closures would “be harmful to children.”

This mixed messaging starkly reflects the reality that the CDC’s mission to reopen schools is at odds with the Trump administration’s intent to open at all odds, said Dan Domenech, Executive Director of the School Superintendents Association (AASA).

The Cost of Reopening

What is certain however, is that a safe return to in-person school comes with a hefty price tag – a whopping 200 billion dollars or more, or about $490 per K-12 student. At a panel discussion on how to safely reopen schools hosted by Ethnic Media Services on July 31, Domenech explained that the costs would cover laptops for students and an array of preventive measures that include sanitizers, masks, PPE and safe busing, before schools could consider opening their doors to staff and students. The expense would place an unprecedented financial burden on overstretched school district budgets in the next academic year.

So, a safe reopening would need a huge injection of federal funds (that the Council of Chief State School Officers projected would cost between $158.1 billion and $244.6 billion,) but the government is threatening to cut funds for schools that don’t fully reopen.

Many school districts cannot afford the expense, so policymakers at state and local levels are choosing to wait before making a decision on whether to reopen schools, based on assessments of COVID-19 threats in their region.

Is it safe to go back to school?

In a press briefing, the White House pushed the idea that the greater risk right now is to children’s learning, rather than to their health and wellbeing, announcing that, “We don’t think our children should be locked up at home with devastating consequences when it’s perfectly safe for them to go to school.”

Till recently, the common belief was that young children were not affected by COVID-19 and were unlikely to spread the virus. In fact the CDC reiterated that children pose no risks, stating that, “The best available evidence from countries that have opened schools indicates that COVID-19 poses low risks to school-aged children, at least in areas with low community transmission, and suggests that children are unlikely to be major drivers of the spread of the virus.”

However, new research from a pediatric hospital in Chicago that published its findings in JAMA, indicates that children carry high levels of the virus in their upper respiratory tracks and may efficiently spread infection by sneezing, coughing or shouting.

“In several countries where schools that have opened prematurely, such as Israel, we have seen a rise in cases,” said Pedro Noguera, Dean, USC Rossier School of Education.

As findings like these make parents and educators uncertain about reopening schools in a pandemic, it may be prudent for school districts to first assess the threat of COVID-19 infections in their area before making plans to send children back to school, suggested by Dr. Anthony Fauci, the nation’s top infectious disease expert, in recent interviews with PBS and the Washington Post.

Inequities in K-12 Education

As schools juggle in-person classes versus online learning and hybrid models, some wealthy families are resolving their uncertainty by creating private learning pods or ‘micro-schools,’ with hired tutors to educate their children. It’s an arrangement that reflects the inequities experienced by less privileged students from special needs, disadvantaged and low income backgrounds. Without tutors or pods, and limited access to internet and laptops, these children are likely to fall further behind and “experience tremendous learning loss,” noted Noguera.

The current education crisis stems froma  lack of leadership, said Noguera, adding that “The real questions facing the US is when will leadership emerge that can provide the guidance that schools need on how to manage instruction…safely … and how to reopen appropriately, in a manner that does not place lives at risk.” He called on local and community leaders to step up in the interim. It will be up to local and community leaders to create innovative ways to deliver education and support children and families, in the short term, said Noguera.

Moving forward into the future will be challenging for schools because the scope of funding required to make changes is not forthcoming from the federal purse . Without adequate funding for health and safety measures in place, Noguera stated that school districts will have to contend with, for example, teacher unions who recently announced they will go on strike over unsafe conditions.

Eleven million children do not have the laptops they need for remote learning, said Domenech. So, even though technology offers valuable learning platforms, it can be a double edged sword, when teachers are ill prepared to use it effectively and students who have little or no access to technology lose out on their learning.

Schools will have to show teachers how to close the “digital divide,” advised Noguera, by training them “to use the technology to deliver meaningful instruction to kids.” But, whatever devices students use for learning, without access to reliable Internet and Wi-Fi, low income and disadvantaged students would face inequities of digital access, warned USC Professor Shaun R. Harper. In LA, school districts have invested in making screens and hotspots available within communities so children can access learning; but children in rural areas have even less connection and risk being left behind.

Noguera suggested that instead of trying to adapt curricula to cell phones, another option would be to go back to “old school approaches to education” using pencil and paper, adding that “they worked before technology, and could work again.”

“For now, whether our education looks like mini learning pods, pandemic pods, micro schools, or collaborative tutoring with college students….that’s still going to provide inequity in our educational system.” cautioned Eddie Valero, Supervisor for District 4, Tulare County Board of Supervisors. He was referring to economist Emily Oster’s prediction that clusters of home schooling families are going to happen everywhere regardless, and “that will create an economic divide.” 

Re-envisioning the future of schooling

Panelists offered several perspectives on when and how schools should reopen.

In working with school superintendents on reopening of schools based on CDC guidelines, said Domenech, the future could feature one of three options – the popular hybrid model, with students on weekly shifts between online learning and in-person classes seated 6 feet apart, total remote learning, or returning to school full-time as before.

However, the continuing rise in infections across the country means that most schools may open remotely. It may be possible for students to return to school only in areas where the rate of infection is below 5%, advised Noguera, suggesting that less risky, outdoor learning may be one way to address the problem. However, places experiencing a surge in cases such as the Imperial Valley in southern California, will have “to rely on community organizations like non-profits to support families and deliver education to children in concert with the school district,” he said.

Noguera’s view was echoed by Mary Helen Immordino-Yang, USC Associate Professor at the Brain and Creativity Institute and Rossier School of Education, who suggested tapping into the “huge cohort of college-ready high school graduates” and using their skills as a resource for tutoring younger students. Engaging young people as a ‘brigade  of community tutors” could help solve the shortage of people in teaching and learning, and give them a sense of purpose,” said Yang.

Professor Harper, who leads the USC Race and Equity Center warned that ‘raceless’ reopening policies from school districts  would “yield racially disparate outcomes”. He suggested that more consultation with communities of color was needed to “racialize input” into the K-12 reopening strategy. That would involve considerations like providing proper PPE, testing and contact tracing for essential workers in schools who are more likely to be employees of color and are disproportionately exposed to infection, as well as trauma and grief support  for staff and students of color, who are more likely to have experienced loss of a family or community member to the virus.

The panelists called on the private sector, specifically high tech companies and philanthropists, to step up and help avert the crisis.

Big tech firms like Amazon said Noguera, which have accumulated huge profits during the pandemic, have a responsibility to assist.

Harper described this timeframe as an opportunity for philanthropists and foundations who want to close racial equity gaps by helping finance “accessibility to learning pods for poorer students who cannot afford it.” There is also a role, he suggested, for nonprofits, youth organizations and college access providers to add to their agendas and recreate pod-like experiences for disadvantaged youth during the pandemic.

Schools are relying on Congress to pass funding that will get K-12 education back on track safely, and Domenech predicts that the majority of schools in America will start the school year with remote learning because, ‘in order to bring any children into school, dollars will be required.”

Valero closed out the discussion by inviting policymakers to re-envision what school should look like for the future by thinking “in creative ways that disrupt our everyday normalcy for something different,” but he urged, “honestly it begins with access, opportunity and fairness for all students.”

“We need to model our classrooms with our most struggling students in mind.”

Meera Kymal is a contributing editor at India Currents 

Image by Katherine Ab from Pixabay; Image by Bob Dmyt from Pixabay

Survive COVID-19 with a Cabin Fever Playbook

What seemed improbable a month ago is today a shared global reality. The steady unravelling of COVID-19 has forced us all – across generations and geographies, to stay home. Morale is low and stress levels are high as we work from home, grieve for and worry about those afflicted, homeschool our children, and struggle to make ends meet in a crumbling economy.

While challenges of confinement and the lack of routine have pushed me out of my comfort zone, strangely, this period has also been a deeply introspective one. I have had teaching moments that have helped me prioritize and gain perspective to effectively navigate these difficult and fluid times.

LEARNING TO ROLL WITH AMBIGUITY
The steepest learning curve for me has been accepting unpredictability and rolling with it. I find myself:

  • Improvising. For example, when I couldn’t find any sanitizers anywhere, I was forced to make my own. My favorite recipe is mixing ¼ tsp of bleach with 4 cups of water.
    When getting my daily yoga stretches seemed impossible, I resorted to CosmicKids Yoga. Now, I get a yoga workout with my preschooler in tow since it engages kids through story and movement.
  • Getting creative. I buy whatever fresh produce is readily and easily available and turn to the internet for inspiration. I’ve dug out my formally forgotten cookbooks and am trying my hand at new recipes.
  • Relaxing standards. With everyone homebound, there’s more mess, less tidiness and meals are often prepared on the fly. But that’s to be expected. Once this realization struck, I recalibrated and lowered standards. This helped me stay calm and centered. Beds don’t always get made, but the sheets are clean. Meals may be prepared on the fly, but they’re healthy. I learned not to sweat it. There’s enough to worry about as is.


STAYING ORGANIZED

I am by no means a planner. But, when I saw the panic around me at our local grocery store, I was jolted into action:

  • To create a weekly meal roster to plan grocery runs.
  • I stocked up on non-perishables. Fortunately, being accustomed to eating and cooking Indian food, between atta (whole wheat), rice, Sabudana (tapioca), pasta, flour, sooji (semolina), besan (chickpea flour), poha (flattened rice), bread, and a few packs of frozen rotis and naans, I had an array of grain options. My new favorite comfort food now is a simple and wholesome Sabudana khichri.
  • To bolster our supply of vitamins, ginger tea, and citrus fruits to keep up our immunity.


COMMUNICATING

At a time when schedules are unpredictable with no school and everyone working from home, things don’t always fall in place as seamlessly as they used to. As a result, I found it vital to effectively communicate household rules and expectations.

  • We have a written daily routine and each person is assigned household chores and responsibilities. That way everyone’s on the same page and knows when and how to chip in. This has provided the much-needed predictability in times of uncertainty and has also fostered teamwork.
  • I am also making the most of this opportunity to double down on conversing in my native language (Hindi) with my preschooler and second grader. I can already see some promising results.

MAKING TIME FOR LITTLE THINGS
I find myself making more time for family. A relatively slower pace of life is allowing more time to connect with each other as well as with extended family and community members. More than before, I see us using FT, Skype and Zoom to connect with each other. Most importantly, I’m enjoying simple activities like:

  • Walking. It is Spring after all! If parks are out of bounds, we take family walks. These aren’t long. Sometimes squeezing in a short walk between meetings or a break is good enough. It’s refreshing to marvel at blooming flowers and seek joy in the many signs of new life and activity around us.
  • Playing. We make up silly games, play board games, word games, card games, Simon says, red light-green light, do messy art projects; all of which fuel our creativity and bring us closer as a family.
  • Baking. Instead of composting that overripe banana, we make banana bread. We roll dough and cut out shapes when we make atta ladoos and atta cookies respectively.


LAUGHING

For some time, I had replaced humor with fear, anxiety and stress. One day, my eight-year-old asked me, “Why do graveyards have a fence around them?” Looking at my confused expression, he promptly replied, “Because people are dying to get in!” With all the dread unfolding, it felt like a scene from a dark comedy movie. It lightened the mood and we all had a good laugh.

I realized that it’s ok to laugh even in the face of adversity. Given our current reality, it’s easy to forget to let some humor into our lives. Besides, doesn’t laughter reduce stress-generated cortisol that kills our immune system? So, why not laugh, boost our immunity and flatten the curve!

To get in some laughs every day:

  • I have intentionally added joke books to our children’s daily reading stack. Kids love jokes and rarely miss an opportunity to share something that tickles them.
  • In the evening, my husband and I carve out some time to watch something funny. It’s a wonderful way to relax, connect and laugh together as adults.

The COVID-19 pandemic continues to be a trying time, stretching our mental and physical capacity to endure fear and uncertainty. Yet, it’s heartening to see folks reach out to provide services like grocery runs or offer free in-home entertainment materials like family games, books and DVDs. We’re connecting with family, friends and our extended community, to make sure we’re all okay. Our children are virtually interacting with cousins, grandparents and friends. I’m reminded of Gilda Radner, who once wisely said – “Life is about…taking the moment and making the best of it, without knowing what’s going to happen next.”

We’re certainly trying our best!

Nidhi Kirpal Jayadevan’s pre-kids’ life was dedicated to the complex field of Communication Sciences. After choosing to be a fulltime mother, reading and playing with her high energy boys has been a fascinating journey. It has (re)kindled in her a sense of wonder in all things small. She constantly sees the world through little eyes, applying simple learnings to deepen life’s meaning for herself and her family.

Edited by Meera Kymal, contributing editor at India Currents

Photo by Jyotirmoy Gupta on Unsplash

AAPI Fights the ‘Rakshas Virus’

Nearly 100,000 Physicians of Indian origin in the United States serve every seventh patient across the United States – This powerful statistic shared by  Dr. Anupama Gotimukula, Vice president of AAPIUSA at a recent teleconference, underscores the significant numbers of Indian American medical professionals involved in the fight against the novel coronavirus.

The teleconference on Friday, March 27, 2020  was jointly organized by AAPI, the Indian Embassy in Washington, DC, and the National Council of Asian Indian Americans (NCAIA).

“While COVID-19 continues to disrupt life around the globe, AAPI is committed to helping its tens of thousands of members across the US and others across the globe,” said Dr. Suresh Reddy, President of AAPI. “We do acknowledge that these are challenging times, more than ever for us, physicians, who are on the frontline to assess, diagnose and treat people who are affected by this deadly pandemic, COVID-19. Many of our colleagues have sacrificed their lives in order to save those impacted by this pandemic around the world.”

The numbers are grim. Coronavirus deaths in the US  are over 3000  (exceeding the initial death toll of September 11), while over 175,000  people have tested positive for the virus – more than double that announced by China.

In response to the pandemic, AAPI has embarked on several initiatives, the most effective being a twice weekly conference call attended by  over 2,000 physicians from across the United States,  to share expertise and best care practices with other professionals from the healthcare sector.

Nearly 200,000 Indian students in the US are impacted by the pandemic, said Anurag Kumar, Minister of Community Affairs, who outlined efforts to give them assistance.

“We are coordinating with the community and hotels owned by AAHOA members in arranging accommodation for students, “ he said. “Everyone is advised not to travel abroad and back to India, stay where you are until things get better.”

Speakers on the forum highlighted the need for the people to recognize that Covid-19 is an aggressive type of virus. “Everyone needs to take appropriate precautions. Even if symptoms are negative, one is likely they carry symptoms,” advised Dr. Bharat Barai.

Social distancing matters cautioned Dr. Prasad Garimella, a critical care medicine specialist . “Social distancing is not isolating. Keep in touch with loved ones. Stay busy and stay connected. Filter and assess the news, look for credible sources to rely upon. Everyone needs to act like a health care professional and need to have the best attitude in order to defeat this deadly virus.”

Emergency medicine specialist Dr. Arunachalam Einstein endorsed  self-quarantine and masks as a way to prevent spreading. “Go out only for essential things,” he advised. “ Everyone coming to ED symptomatic and non-symptomatic and the staff must wear mask, which will prevent droplets from affecting others.   Even when going out to grocery shopping use masks.”

Dr. Sudhakar Jonnalagadda, expressed concern about the adverse effect of inadequate testing for at risk seniors, as well as for physicians  and healthcare workers fighting infection on the frontlines, stating  “It’s essential to create a wholesale expansion of free COVID-19 testing available in order for identifying asymptomatic carries and then isolating them.”

A rising number of people across age groups are affected by the highly infectious virus, said Dr. Usha Rani Karumudii, an infectious disease specialist, reporting that “People of all ages are prone to the disease. Hand hygiene and social distancing will help prevent. Precautions while shopping, reduce trips. wash and decontaminate hands after going out.”

AAPI also has launched a DONATE A MASK PROGRAM – a major initiative to protect the medical fraternity as they combat the “rakshas” virus.  Members were requested to donate generously to fight “this ferocious virus which has put basic existence of entire human race at stake.”

A severe shortage of GS masks and other protective gear is impacting  “the foot soldiers and front line physicians,” some of whom have succumbed to the deadly virus. A donation box labelled “DONATE A MASK,” has been added to the AAPI website ands a task force established to identify hospitals and direct supplies of Masks/PPE.

Updates  on AAPI initiatives  can be found at  www.appiusa.org

 

 

 

Unity in the Face of Virus-That-Must-Not-Be-Named

“This is the Ministry of Magic all over again!” I said.

The Ministry of Magic, as Harry Potter fans know, completely botched up the rise of Voldemort. The Minister and his administration were in denial, then went on a campaign of outright lying with false facts, bravado, and then a rude reckoning of the truth. The Order of the Phoenix is one of those books that really opens our eyes to incompetent leaders.

We were discussing the United States’ handling of the Coronavirus, COVID-19 health threat.

Everywhere on social media there was information – some true, some untrue, some alarmist, some pacifist, many telling us not to worry, but worrisome all the same. Our President, it seems, has not yet arrived at the true reckoning of the situation, and continued his bravado. The President blundered on about his building walls to stop the spread, his biggest problem seemed to be the Stock market index.

Meanwhile, the CDC did not have enough testing kits ready, so we do not know how pervasive the situation really is. While unprecedented, it is also concerning that we knew the world is more connected than ever, and yet did not prepare as a country. 

Vox article: here indicating that US is lagging behind most developed countries for testing Covid-19.

The World Health Organization declared the situation a pandemic on Mar 13th 2020. A pandemic knows no borders. Derived from the Greek roots, pan meaning “all” and demos meaning “people”, it denotes diseases that spread across multiple continents or worldwide.

The article here on WHO site lists the stages of planning and preparedness required for a pandemic. 

We all pass through phases of denial, a state of holy-moly, and a surreal settling in to things. (I had been vacillating between astonished denial & mild panic, up until the 1st week of March in California). We do the best we can. We see the terms quarantine & social distancing, and try to come to terms with this new mode of functioning. We are social animals now united by the need for social distancing.

Our company announced an ‘Encouraged to Work From Home policy’ like many other tech companies. That has now been upped to a ‘Mandatory Work From Home’. I know many of us used the public transit systems to get to the office, so we were obviously grateful to be told this, and to have the kind of jobs that can be done remotely for a short period of time. It was not lost on me that a great many people did not have the same luxury. What will this mean for them?

Covid-19 is unprecedented for many of us. People who had lived through the SARS outbreak 18 years earlier are probably the ones who have seen something similar in their lifetimes. For the vast majority of us though, this is new territory. How do we determine the best sources of information?

How do we learn lessons from the countries who are already dealing with the situation? Taiwan, China, Singapore. How did Italy quarantine their entire populace? What are the ways in which Society will be affected with this social distancing? It remains to be seen.

While the man at the top may not be taking Covid-19 as seriously as he should, local & state governments stepped up with proactive measures such as a call for Sheltering-in-place that was imposed across 7 counties in the Bay area affecting more than 7 million people. These are unprecedented measures. People are turning to their local leaders in their times of need. Many organizations have gone above and beyond canceling unnecessary travel, conferences, gatherings etc.  

To protect the vulnerable among us, we will need immediate plans, short-to-medium term plans and long term plans. We are currently in the immediate response mode. 

Humanity always comes together in the best & worst of times. When our leaders do not provide timely guidance, our collective reasoning can, and much like the Wizarding World united in the face of Voldemort, I am sure we shall do the same this time around: by collectively, voluntarily, distancing ourselves socially, being responsible, and putting the greater good ahead of us.

  • If you are reading every article on Covid-19, and wondering what to do in all the doomsday scenarios described, take heart, practice social distancing and follow guidelines set out by the WHO & CDC. 
  • If you are taking Covid-19 far too lightly and continuing to hang out with your friends, please watch this TED talk given by Bill Gates in 2015. He says our next big catastrophe to prepare for is not missiles but microbes. 

This time, it seems we are struggling against the onslaught of the Coronavirus.

The tiniest virus, it seems, brings us closer to the human condition than any other thing can. We are human and are therefore at risk.

Saumya Balasubramanian writes regularly at nourishncherish.wordpress.com. Some of her articles have been published in San Francisco Chronicle, The Hindu and India Currents. She lives with her family in the Bay Area where she lilts along savoring the ability to find humor in everyday life and finding joy in the little things.


Image licence can be found here.

In the “Age of the Coronavirus” – A Reflection

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.

Sigh. 

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.’

“On Living in an Atomic Age” (1948) in Present Concerns: Journalistic Essays”

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 of Sukham, 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

Do It For Others: COVID-19 Pandemic

How is it affecting our lives in the United States?

I am a medical director of a community hospital based clinical pathology laboratory. We have been preparing for the COVID-19 for a few weeks at the hospital. It became urgent and real when someone rushed into the lab through the patient collection area to steal hand sanitizer and masks. Then we started getting calls from the emergency department. The virus was literally within an arm’s reach! The wolf was huffing and puffing at our door! We have currently 6 confirmed cases in Alabama. This prompted me to write an article about all the facts I have gleaned by talking to my medical colleagues. 

What has happened?

In 2019, an animal virus of the Coronavirus family jumped from a small mammal into humans. MERs and SARs are two other examples of viral infections that spread from animals to humans and caused epidemics in the recent past. The epicenter of COVID-19 was in Wuhan, China but now it has infected more than 149596 people and caused more than 5604 deaths in several countries world wide. The reported overall mortality rate varies from 0.6 to 4 percent. Children under ten don’t show symptoms but those over the age of 60 with other comorbid conditions are at risk of developing pneumonia and dying. To put it in perspective the mortality rate may be taken as 1 percent if you are fifty. 2-4 percent of you are sixty. 8-10 percent of you are seventy and 50 percent or more if you are eighty. There are more infected people around us who are shedding virus in droplets because they have not been tested, or the test came back negative because it was improperly collected.

What are the symptoms?

High fever, body ache often described as the worst flu with slight betterment of simpletons followed by difficulty breathing and dry cough. Some people have nausea, vomiting and diarrhea. 

How does it spread?

When an infected person coughs or sneezes, the virus particles enter the air around him in the form of droplets and then settle on the surfaces which can be contagious from 1-9 days. The virus survives for 1-2 days on paper but longer on glass, granite and handles. 

Why is it bad?

This is a new virus that we do not have any exposure to and it seems to be more infectious and contagious than influenza to the tune of 1: 40 compared to 1:9. Unlike Ebola or SARS, infected people can shed it in the incubation period while being asymptomatic and also after they have recovered. The most vulnerable people are the elderly in nursing homes who are suffering from congestive heart failure, COPD, hypertension, diabetes, cancer and other autoimmune diseases. 

What are the limitations? 

As we have seen in China and now in Italy, and other countries in Europe, COVID 19 infections have exponentially increased overwhelming the health system: isolation resources, health care providers and ICU beds providing life support to the critically ill. 

How is it tested?

Your health care provider will collect a sample from your nasopharynx (high up in the nose) and put the collected sample in a special viral transport medium to send it frozen or refrigerated to the testing laboratory. The results will be released to your provider. The federal and state governments are working overtime to make tests available to everyone in the near future. The vaccine is being tested and may be available to us by the end of this year. 

What we all can do

  • Social isolation by staying about six feet apart, not shaking hands, hugging or touching your own or others face. Indian Namaste is the best greeting! 
  • If you have to travel in a public transport, don’t touch the handrails and handles with bare hands.cruise ships are a complete NO! In the plane, wipe down your seat and hand rests and preferably sit on the window side with the air vent blowing directly on your face. 
  • Cover your cough and sneeze properly. 
  • Wash your hands thoroughly, cleaning, fingertips, thumbs and backs of hands. I chant the Gayatri Mantra twice while working up the soap suds. 
  • At the gas station use a paper towel to pump gas and knuckles to punch in your zip code. 
  • It is best to keep children at home because although they don’t get sick they can transmit the virus to grandparents and elderly relatives. 
  • Don’t share food, don’t eat snacks in between meals while working. Stock up on essentials, like water, canned vegetables, lentils, rice and medicines. 
  • You do not need to wear a mask right now unless you are sick to protect others from droplets. You do not need a N- 99 mask because the viral particles are bigger and an ordinary medical mask can serve the purpose. If you wear a mask, dispose of it properly.
  • If you are sick stay at home because even if you are not feeling poorly you can prevent spreading the disease to others. If you think you have the symptoms get in touch with your medical provider and they can help you with testing. Apart from state departments of health, private laboratories like LabCorp and Quest are testing for COVID-19.

What I have done 

  • Stopped all congregations: Churches, celebrations, museum events, literary gatherings, medical conferences, nonessential travel. 
  • Stopped cleaning service and nonessential shopping. 
  • I have designated clothes, outerwear and purse etc. for work and wash those items daily. 
  • I don’t wear shoes at home and clean all surfaces by spraying them with disinfectant spray. 
  • I only use a few areas in my home and have made a “hot zone” in the basement to isolate if any of our family members get sick. 
  • I put all sheets, comforters and sweaters in the sunlight when I can. I keep the temperature higher in my bedroom and have a humidifier to prevent the air passages from drying and allowing virus to enter. 

In conclusion

Stay clean, stay safe, stay informed. Do not take this as a joke. Do not hoard toilet paper or masks. Please help in every way you can to flatten the epidemic curve so that we can handle the sick patients without running out of supplies especially ICU beds with respirators. 

Remember, social distancing is not an act of fear it is an act of love and care.

Monita Soni is a pathologist and a free lance journalist in Madison Alabama.