CME INDIA Presentation by Dr N K Singh.

Scenario1:

• Delhi’s COVID situation is reported to be extremely bad. In comparison, Mumbai reports a satisfactory stabilization. Most of cities are comfortable, except few.
• Blame it on citizen’s unsafe mentality, unreasonable behaviour and false sense of security, temperature and pollution. Nothing explains the way Delhi is behaving. If crowds are at Delhi, almost same scenario is at Kolkata, Mumbai and other cities.
• Recently one of my known friends developed cough and fever after returning from Patna on 13th November and just after two days expired at age of only 45. Well, he was diabetic, but this does not explain the so-fast downhill course. His wife and other members, who remained fully exposed to the virus – slept with him, dined with him and wore no masks for 2 days (before test came positive) – surprisingly escaped the infection.
• So, even dynamics of transmission is not known.

Scenario 2:

• From Hydroxyquinoline to Remdesivir, Plasma therapy to Favipiravir, Ivermectin to Methylene Blue, everyday treatment protocols keep changing. No uniform treatment exists.
• Recent blow is to Remdesivir – WHO strongly disapproves it. But irony is that nobody is going to listen. Only thing, WHO does not say how come China is reporting zero growth of COVID while rest of world is horrified by it? If means and ways of Chinese success story exists, why doesn’t WHO tell us?

Vikram and Betaal Story

• COVID and Science now mimicing an Indian mythology story of the legendary king ‘Vikram’ and the ghost ‘Betaal.’
• King Vikram needs to find a very ancient tree where a corpse hangs from one of its branches and bring it to a mendicant.
• The mendicant would get certain occult powers by practicing certain rites by sitting on the corpse.
• In order to fulfil a vow, King Vikram tried to remove the corpse of Betaal from a treetop on 25 occasions and carry it on his shoulder to another place in complete silence.
• Every time Betaal would narrate a story to the king and after completing the story Betaal would then pose a query that the king must answer, else he will break his head into a thousand pieces.
• But if he does speak out, he would break the vow of silence and Betaal would fly back to the treetop.
• Betaal is asking and Science is trying to answer. At length, all gets dismantled due to wrong response.

CME INDIA Discussion (20/11/2020)

Dr N K Singh: So EASD 2021 also ruined 🧭😇😇

• Mail received just now from EASD (European association for study of Diabetes) – Dear colleagues and friends, Due to the ongoing global impact of the COVID-19 (Coronavirus SARS-CoV-2) pandemic, and the continued uncertainty regarding the travel, events, public gatherings and public health in the year to come, the EASD Board has deliberated, extensively, on the structure and format of the EASD Annual Meeting in 2021. As a result of these deliberations, the EASD Board has unanimously decided to run the EASD Annual Meeting as an online event in 2021.
• So, No Real Conferences in 2021 too! They cancelled a conference scheduled to be held in September 2021. Everyone is totally fed up with Virtual webinars and have reached a breaking point.

Dr K N Manohar Bengaluru: 😭

Dr Meena Chhabra, Diabetologist, Delhi:

• Sir jaan Ki chinta ho rahi hai. Conference to hoti rahengi.
• Delhi in a very bad state. Patients and relatives in Delhi screaming at us doctors – please arrange a bed/ The next threatening line is – we have been your patients for 25 years/ I am at my wits end/ Want to scream back/ Why were you enjoying Diwali parties/ And exchanging gifts/ Attitude?? Here in Delhi a huge issue.

Dr N K Singh: Do not understand, why only Delhi.

Dr Purvi Chawla, Mumbai: Night Curfew in Ahmedabad also.

Dr Ambrish Mithal, DM Endo., Delhi: I am struggling to find a good explanation. Delhi is really on fire. Will it spread everywhere (I hope not) or something unique about Delhi?

Dr Raju Sharma, Jamshedpur: Maybe the hinterland will experience an explosion 1 month later. Same thing happened in first wave.

Dr Ambrish Mithal, DM Endo, Delhi: That’s really scary.

Dr Basab Ghosh, Agartala: It has to behave same like first wave. Mega city to smaller to smallest! We should get the thrust after 3 to 4 months like before.

Dr N K Singh: Till then, you get vaccine.

Dr Basab Ghosh Agartala: If not get reinfection before!! 😊 Hopefully these waves are not powerful!!

Dr Awadhesh K Singh, DM Endo., Kolkata:

• 4 weeks back Bengal and Delhi had a difference of 10K COVID-19 that was going neck to neck for next 2 weeks, but now difference is 50K. I had a feeling that Bengal would cross Delhi considering Durga puja 2 weeks back but opposite had happened.
• High court ban on Puja and Diwali gathering – 0 crackers – general public is slightly more sensitive/ or fearful – all put together. The biggest anticipated fear of rise in COVID-19 is opening of local trains from Sealdah and Howrah just before Diwali 😩

Dr Swati Srivastava, Sr. Prof of Med, SMS Medical College, Jaipur: Jaipur is also facing one of the worst times. Sudden surge of cases to double Beds, ICUS not available. Very high oxygen requirement. Only not coming out so openly in the media, wonder why?

Dr Shashank Joshi, DM Endo, Mumbai:

• My take, Delhi is a melting pot of India where a lot of intra country and global travel occurred, compound with lower temperature and pollution.
• All these factors plus public transportation being open and poor masking, no distancing lead to this. This may occur elsewhere also – Haryana, Gujrat particularly Ahmedabad, and many others.
• We fear Mumbai also has a similar issue but lesser pollution and higher temperatures has delayed the peak.
• Only peculiar thing about Mumbai is again COVID-19 inappropriate behaviour is lesser cases, is it herd or is it less testing. Today we tested 16k with 1000 plus with 6 percent TPR, which is same as Delhi.
• What worries me for Delhi is younger population without comorbidities are critical and dying.
• We all pray that we get out of this. Singapore has no single case since last 9 days. They are super strict on every single case.
• Mumbai – only difference is the citizen movement, home to home survey, still public transportation is restricted and aggressive Test, Isolate & Treat policy.
• Reckless behaviour has no solution. Now we have all these jumbos which govt. has kept open till Dec 31st due to a potential peak.
• One of my doctor friends informs:
  • In Singapore phase 2 restrictions are still on, even though we have not had a community case for 9 days now.
  • Along with strict check in and check out at every place, we still have these restrictions, maybe you should consider this for Mumbai:
    • You can’t invite more than 5 people to your house (including children).
    • You cannot step out in a group larger than 5.
    • If you are in a group larger than 5 then you cannot mingle together – At all, if caught, massive fine. Plus, the establishment you are at, can have license suspended for 10 days.
    • Every place shop including the beaches have a max capacity. Shops exceeding max capacity are fined and/or license is suspended for 3 days (minimum).

Dr Harish Darla, Mysore: Regarding Singapore. Strict laws and law-abiding citizens and less population to tackle. Weather wise hot. Can’t be replicated in Indian context.

Dr Basab Ghosh, Agartala: Initially transition was from winter to summer. Now it’s summer to winter, might be virulence would change for this new transition and causing different picture! I believe, Karnataka and Maharashtra are doing good management. Home quarantine is sincerely organised. Screening is also best.

Dr Shashank Joshi, DM Endo, Mumbai: Delhi recorded a minimum temperature of 7.5 degrees Celsius today – the lowest, in this winter season, which begins from the month of October. This is due to snowfall in plain and hilly areas. This dip in temperature will continue for next 2 days. If this is true it will only make COVID-19 worse.

Delhi Belly

• Delhi markets/ Crowd was maddening / No social distancing / Delhiites are hardly interested in following COVID gidelines/ Delhi – one of the first cities that opened markets and even removed restrictions on liquor shops.
• Blame it on Increased testing, which led to Delhi’s COVID spike.
• A Niti Aayog assessment said an unprecedented situation has emerged in Delhi, which could worsen in the coming days. But largely IGNORED.
• Here is no direct connection between the spread of the virus and temperature. Certain behavioural changes during winters that might increase the rate of infection.
• Pollution and COVID virus “A combination of these two becomes deadlier.”
• The serosurvey report from September had reported that 25.1 percent of Delhi’s residents had developed antibodies.
• 43.5 percent of those who were found to be COVID-positive earlier, had been found seronegative during the October survey.
• The primary focus of the Maharashtra government was extensive testing.
• However, data reveals that Delhi has tested thrice the number of samples than Mumbai.

CME INDIA Learning Points

(Dr B B Thakur, Ex National President, API)

• I am pained to see the current status of COVID-19 across the country especially Delhi and Bihar.
• We have played havoc by holding rallies, Meetings, election, Vijay julus, and huge gatherings in all types of market for purchasing and enjoyment with Resultant rise in CORONA.
• Is it wise to be a party to disease, death and destruction?
• You must have been bored by the voice of a COVID-19 patient Amitabh Bachan but essential for deaf like us, excuse me for being rough.
• Let me once again request you all to observe the following:
  • People over 65-70 Yrs. of age ESPECIALLY WITH DISEASES should go out only on a very important unavoidable work with all necessary precautions.
  • Doctors to give teleconsultation and maintain all precautions IN OPD.
  • Patients to avoid going to doctors. They should GO only on emergency otherwise go for teleconsultation.
  • Avoid marketing, otherwise maintain all safety measures like personal distance, mask and personnel hygiene if you have to go necessarily.
  • Coming 6 Months of your life period is very important and keep it healthy by using protective measures, great life awaits thereafter.
  • There is light after the tunnel.
  • Doctors and public of all age groups are vulnerable to get the disease.
  • Till date no drug is available.
  • BOOST YOUR IMMUNITY BY YOGA, PRANAYAM, WALKING, AND CONSUMING HEALTHY, NONSPICY PLANTS BASED AND WHOLE GRAIN FOOD, FRUITS VEGETABLES, NUTS AND LEGUMENS.
  • Good sleep for at least 7 Hours.
  • Always be positive.
  • Spend happy time WITH FAMILY.
  • CONTACT WITH LIKE MINDED FRIENDS AND SPIRITUAL GROUPS. DO PRAYER CHANTING PUJA.
  • Spread EMPATHY NOT CORONA.
• Heavy punishment of Rs 1000 should be imposed for Violation of advice of mask and distancing.
• LIFE IS PRECIOUS PLEASE TAKE CARE.
• YOUR LIFE IS IN YOUR HANDS.

CME INDIA Tail Piece

Why Betaal escapes each time now? He asks last question – why China shows this graph?

King Vikram’s response is ZERO

Vikram has no answer

So, Story continues…

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