Is India generously over reporting covid numbers?

Should all the covid patients be isolated? Are they all infectious? No. Only those with sufficient viral loads would infect. If so, why not judiciously detect the high viral load patients?

There is a growing concern among the epidemiologists that the widely used, RT-PCR, a gold standard test, is so sensitive that it is not that useful in the present phase of pandemic. In RT-PCR, the number of amplification cycles needed to find the virus, called the cycle threshold, Ct, is set in most of the machines by the manufacturers at 40, a few at 37. This sensitivity is set from the point of view of not to miss the RNA at ‘any cost’.

Would this high sensitivity be counter productive now?

A major drawback of PCR and other diagnostic approaches (including RAT) is that they all fail to determine virus infectivity; PCR sensitivity is excellent but specificity for detecting replicative virus is poor. A typical study (3), involving symptomatic individuals, utilising a cross-sectional approach to correlate COVID-19 symptom onset to specimen collection with SARS-CoV-2 E gene RT-PCR and virus viability as determined by cell culture was conducted. These results demonstrate that infectivity (as defined by growth in cell culture) is significantly reduced when RT-PCR Ct values are > 24. For every 1-unit increase in Ct, the odds ratio for infectivity decreased by 32%. The high specificity of Ct and STT (Symptoms To Test) suggests that Ct values > 24, along with duration of symptoms > 8 days, may be used in combination to determine duration of infectivity in patients.

In another study (2) of three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, it was found that up to 90 percent of people testing positive carried barely any virus. They had Ct values set between 37-40.

Any test with a cycle threshold above 35 is too sensitive. Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left.

People infected with the virus are most infectious from a day or two to about five to eight days after getting infected irrespective of appearance of symptoms. But with a low Ct threshold, the start phase might give a negative result. But in a few days, the viral load would increase sufficient enough to get a ‘positive’ and again it will taper out to give a ‘negative’. Only a delayed, repeat test (with a gap of 4 or 5 days) could confirm the phase! But at the current testing rates, it is impossible to do frequent testing to capture somebody in that window. It is more so if the person is asymptomatic with potential viral loads. Repeat tests, while only some can afford, may be a heavy burden on the health infra if adopted as a policy by the state.

From these analysis, there appears a strong case for lowering the threshold which is set very conservatively in India at 40. But, it is discounted by many, including the ICMR. Why ICMR is not inclined to take these suggestions and update their advisories, which are now followed in the west? The concern is from the fact that the amount of viral loads collected in swabs is not quantitative. Hence detection could differ even with same Ct values? Hence it would not give a reliable guidance. But, a conservative cutoff could be 30 to 35, may be at 30 could be a solution.

Alternatively, if Ct in RT-PCR could not give a dependable conclusion, then why not adopt RAT, that would only qualitatively give positives based on the ‘infectability’. The usual blame of ‘false negatives‘ that is missing out some positives (5%) may be due to low viral loads.

The latest protocol and advisory of ICMR on this strategy encompasses most of the concerns. It is now for the implementing states to follow. Higher dependence on RT-PCR by some states could delay the end of the ‘war’.

There is yet another dimension to the high sensitivity of RT-PCR: one may not get a negative test after the standard two weeks isolation. Only an anti body test could confirm the absence of infection. In some states, negative tests are demanded for removing the quarantine requirement. RT-PCR may be a gold standard since it detects even a fragment of dead virus! But would it not mislead the less informed health authorities?This could also be a reason for ‘alarming‘ reports of ‘reinfection‘!

Presently, the strategy of isolation of the infected is until 2 negative NP RT-PCR results 48 hours apart after 14 days of symptoms. Since, RT-PCR positivity persists significantly beyond infectivity is It is appropriate to adopt the Clinical criteria of 14 days from symptom onset or 72 hours symptom free (whichever is longer), to avoid any unnecessary isolation, and use of personal protective equipment and testing resources. And avoidable restrictions to the infected and their near and dear.

For asymptomatics, a 14 day quarantine without retesting would be sufficient.

The RT PCR with the present protocols would not at all miss a positive case but, some ‘false positives‘ can’t be ruled out. On the other hand, why not accept certain missed cases with Rapid Antigen Test that gives some ‘false negatives‘. If RAT is adopted to test only for asymptomatics, the error would not be damaging from infection control point of view: The missed cases would not spread the infection as RAT misses them only due to low viral loads. The error is manageable and acceptable in such demographically large and economically challenging country like India.

But, for heaven’s sake let us not report unnecessarily high case numbers with very sensitive RT-PCR, and frighten the general public.

Credits:

1. https://in.dental-tribune.com/news/cycle-threshold-ct-value-of-rt-pcr-can-tell-us-if-a-sars-cov-2-infected-person-can-spread-disease/

2. https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html?referringSource=articleShare

3. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa638/5842165

சொல்லில் சிலம்பமாடும் காளமேகம்

இலக்கியங்களில் சிலேடை என்பது ஒரு அலங்காரம். ஒரு பொருள் தரும் சொல் வேறு ஒரு பொருளையும் மறைமுகமாய்க் குறிக்குமானால் அது சிலேடை ஆகும். சிலேடை நயத்துடன் எழுதப்படும் கவிகள் அந்தக்காலத்தில் மிகவும் ரசிக்கப்பட்டதுடன், புகழ் பெற்றும் விளங்கியது.

வடமொழி சமஸ்கிருதத்தில் காளிதாஸின் சிலேடைநயம் வெகு பிரசித்தம். தமிழில் சிலேடையாகவும், நையாண்டியாகவும் பாடுவதில் சிறந்து விளங்கியவர் கவி காளமேகப் புலவர். அவரது சில சிலேடைகளை இங்கு ருசிக்கலாமா?

“தகர” வருக்கமே முற்றவும் அமைந்து வருமாறு அமைந்த  பாடல் இது. உரத்துப் படிக்கும்போது பேசும் சக்தியற்ற ஊமை மனிதன் பிதற்றுவது போல இருக்கும். தகர வரிசை எழுத்துக்களை கண்டவிதமாக அடுக்கி எழுதிவைத்துள்ளது போல தோன்றும். ஆனால் ஆழ்ந்து படித்துக் கருத்தை அறியும்போது காளமேகப்புலவரின் திறமையை மட்டுமல்ல, தமிழ்மொழியின் வலிமையையும் எண்ணி எண்ணி இறும்பூதடையாமல் இருக்க முடியாது.

தத்தித்தா தூதுதி தாதூதித் தத்துதி
துத்தித் துதைதி துதைதத்தா தாதுதி
தித்தித்த தித்தித்த தாதெது தித்தித்த
தெத்தாதோ தித்தித்த தாது?

தத்தித் தாது ஊதுதி – தாவிச் சென்று (தாது=பூவின் மகரந்தம்) பூவின் மகரந்தத்தை ஊதுகிறாய்;

தாது ஊதித் தத்துதி – மகரந்தத்தை ஊதி உண்ட பின் வேறேங்கோ செல்கிறாய்

துத்தித் துதைதி – துத்தி என்று ரீங்கரித்தபடியே அடுத்த பூவிற்குச் செல்கிறாய்

துதைது அத்தா ஊதி – அப்பூவையும் நெருங்கி மகரந்தத்தை உண்ணுகிறாய்

தித்தித்த தித்தித்த தாதெது – இரண்டிலும் தித்திப்பாக இருந்த மகரந்தம் எது?

தித்தித்த தெத்தாதோ தித்தித்த தாது – தித்திப்பான பூ எது? அழகான பூவின் இதழ் எது?

இந்தப் பாடலில் “தாது” என்னும் சொல் “மகரந்தம்”, “பூ”, “பூவின் இதழ்” ஆகிய  மூன்றையும் குறிப்பிடுகிறது

வண்டைப் பார்த்துப் பாடும் விதமாக அமைந்தது இந்தப் பாடல். தத்தித் தாவி பூவில் (மலரில்) இருக்கும் தாதுவாகிய மகரந்தத் தூளை திண்ணும் வண்டே! (நீ) ஒரு பூவினுள் (மலரினுள்) உள்ள தாதுவை உண்ட பின்பு மீண்டும் மற்றொரு பூவிற்குச் சென்று தாதெடுத்து (மகரந்தத்தை எடுத்து) உண்கிறாய். வண்டே உனக்கு எந்தப் பூவில் உள்ள தேன் (எத்தாது) தித்தித்தது (இனித்தது)? இதுவே  பாடல் விளக்கம்.

மகரவரிசையிலும் ஒன்று:

மானமே நண்ணா மணமென் மனமென்னும

மானமான் மன்னா நனிநாணு – மீனமா

மானா மினன்மின்னி முன்முன்னே நண்ணினும்

மானா மணிமேனி மான்

மானம் மான் மன்னா – பெரிய யானைகளையுடைய வேந்தனே!, ஆனா மினல் மின்னி – நீங்காது மின்னானது விளங்கி, முன் முன்னே நண்ணினும் – முன்னே முன்னே தோன்றினும்,மானா மணி மேனி – ஒவ்வாத அழகிய உருவத்தையுடைய, மான் – மானை யொப்பாள், மானமே நண்ணா மனம் – மானம் யாதும் மேவாத உள்ளம், என் மனம் என்னும் – எனது உள்ளம் என்னும்; நனி நாணும் – மிகவும் நாணும் குறைபடா நிற்கும்; ஈனமாம் – (ஆதலால், நீ இதுவரை வரைந்து கொள்ளா திருத்தல் நினது பெருமைக்குக்) குறைபாடாகும.

ககர வருக்கமே முற்றிலும் அமைந்து வருமாறு ஒரு செய்யுளைச் செய்க” என்று கேட்டவருக்கு விடையாக இந்த பாடல். மேலோட்டமாகப் பார்த்தால் ஏதோ உளறுவதைப்போலத்தான் இந்தப் பாடலும் தோன்றும்.. சொற்களைப் பிரித்து, பொருள் கண்டு படித்தால் தமிழின் சுவையில் உள்ளமெல்லாம் இனிக்கும்..

காக்கைக்கா காகூகை கூகைக்கா காகாக்கை

கோக்குக்கூக் காக்கைக்குக் கொக்கொக்க – கைக்கைக்குக்

காக்கைக்குக் கைக்கைக்கா கா.

“காக்கைக்கு ஆகா கூகை – இரவில் காக்கையால் கூகையை (ஒரு வகை ஆந்தையை) வெல்ல இயலாது. கூகைக்கு ஆகா காக்கை -பகலில் கூகையால் காக்கையை வெல்ல முடியாது. கோக்கு கூ காக்கைக்கு (கோ = மன்னன்; கோக்கு = மன்னனுக்கு; கூ = புவி; காக்கைக்கு = காப்பதற்கு) – (அதனால்) மன்னனுக்கு அவன் நாட்டைப் பகைவரிடமிருந்து காப்பாற்றுவதற்கு; கொக்கொக்க = கொக்கு ஒக்க – கொக்கைப் போலத் தகுதியான சமயம் வரும் வரை காத்திருக்க வேண்டும், கைக்கைக்கு – பகையை எதிர்த்து, காக்கைக்கு காப்பாற்றுவதற்கு, கைக்கைக்கா கா = கைக்கு ஐக்கு ஆகா (காலமற்ற காலமாயின்) சாமர்த்தியமுள்ள தலைவனுக்கும் இயலாதாகிப் போய்விடும்”

கவியரசரின் அத்திக்காய் ஆலங்காய் பாடலுக்கு இதுதான் முன்னோட்டமோ?

இக்கால கவிஞர்களும் இவ்வகையில் சளைத்தவர்கள் அல்ல. தமிழ்த்திரைப்பாடல்களில் சிலேடையை புகுத்திய கவிஞர்களில் முன்னோடி கண்ணதாசன்.

பலே பாண்டியா படத்தில் அத்திக்காய் காய் காய், வீர அபிமன்யு படத்தில் பார்த்தேன் சிரித்தேன், ரகசிய போலீஸ் 115 படத்தில் பால் தமிழ் பால் என்று பாடல்களில் முறையே காய், தேன் பால் என்ற சொற்களைக்கொண்டு  சொல் சிலம்பம் ஆடி மகிழ வைக்கிறார் கவியரசு.

நமது இந்நாள் பாடதிட்டத்தில் ஏன் தமிழை சுவைக்க கற்றுத்தருவதில்லை என்பதில் எனக்கு வருத்தம்தான்.

இது எல்லாம் ஒருபுறம் இருக்கட்டும். ஒரு கேள்வி:

‘ழ’கரம் வேறு மொழிக்களில் இல்லாத காரணம் என்னை வெகு நாட்களாகவே துளைக்கிறது. நண்பர்களிடம் விடை இருந்தால் பகிரலாமே.

‘ழ’ உச்சரிக்க இயலாத தமிழ் நாக்குகளுக்கு என்ன தண்டனை தரலாம்?

Safety Protocols for Sanjeevini

Would Lakshman have survived had the safety protocols, now insisted for Covid vaccine, were in vogue during the Ram-Ravan war? Ram would have resisted Jambavan’s impromptu prescription of ‘sanjeevini’ brought through Maruti’s ‘himalayan’ journey! Luckily, there was no drug controllers around then. Why the present day ‘drug control’ regime not take inspiration from Ramayana? Could a vaccine under development become a Sanjeevini?

Vaccines are approved for mass deployment only after thorough phased protocols. Many vaccines are in pipeline but only a few are closer to the winning mark. Some have reached the final stage 2 and 3 phases. Since a vaccine is cleared for mass immunisation only after the stage 3 trials, with quite a few in stage 2, it is pertinent to understand the significance of the trial stages.

Stage 1 is animal experiment while 2 & 3 are human trials. Stage 2 trials are designed to establish safety, that is whether the vaccine gives any adverse or side reaction. Volunteers selected are to be healthy otherwise and the number should be small may be a few hundreds with close follow ups.

Stage 3 is to establish the effectiveness. The Volunteers from all segments are identified for reliable statistical analysis. The thumb rule for crossing the winning post in this trial, is that the number of people infected subsequently, should be less than the control group, that is given placebos. Under normal circumstances, a vaccine will be accepted as effective and considered for approval if the number affected in the control group is 50% more. The number of recorded infections is set at 150 by many regulators. Independent panels of experts called data and safety monitoring boards (DSMB) will review trial data at pre-specified points in both the stages. These boards can recommend companies stop the trials if the evidence is overwhelmingly positive or negative.

Presently vaccines from Astra Zeneca, Pfizer and Moderna are in stage 3 trials. These vaccine trials which have enrolled thousands of people, say they may have proof of effectiveness of the vaccine, after just a few dozen subjects become infected. Would it be considered too low or adequate for emergency approval? With the infection in waning phase, would there be any fertile ground for statistically sufficient number of infections? Or Would one country accept a finding of infection data in any other country? The vaccine trial is at its controversial crossroads for approval and commercial deployment .

Should one have to wait till all the safety tests are completed in Phase-3 or deploy vaccines based on risk-benefit analysis? Especially in ‘pandemics‘? Would it not be possible to build adequate ’fine prints’ to absolve all the parties involved in the immunisation chain, if it all it statistically misfires later? No doubt compensation claims have to be contended with, whatever may be the well meaning ‘shortcuts’ are! Should the manufacturers set aside a part of the ‘booty’ while costing the ‘magic portion’? Regulators also can charge hefty levies for such ‘emergency approvals’ should there be any need to compensate the victims on a later date! It would also keep all the parties, those who follow the lengthy protocols and who bypass them through shortcuts, on a level playing field! Otherwise they will be accused of ‘kickbacks‘!

UK and USA would lead the list of liberal nations in wriggling a way out of the conundrum! UK is already rewriting its laws to allow emergency use of any effective coronavirus vaccine well before it is fully licensed; The proposed regulations would permit emergency approval, allowing people to be immunized while the full licensing process is sill being finished! Wouldn’t rewriting such protocols raise the eyebrows? Proverbially, if law makers who frame the laws themselves can not rewrite their own guidelines, who else has the rights?

It is trumpeted that the United States may have four Covid-19 vaccines would be in large-scale clinical trials by the middle of September, so that the programme of approval of tens of millions of (doses of) safe and effective vaccines be available by calendar year-end. Would CDC match the pace of frustrated Trump whose earnest wish is not only to save his dear citizens, but also his chair as well! China and a Russia have already started their immunisation programmes while their vaccines are still in Stage 3 phase!

If the vaccine’s safety is assured with phase 2 clearance, would it be ethically wrong to shortcut the stage 3 or to be more precise, is it not unethical to delay the inoculation of front line workers and possibly save precious lives! Would it not be a good idea for healthcare workers and vulnerable subjects to enrol in the COVID-19 vaccine Phase 3 trials at least in India where the pandemic is raging? If this is to be done quickly, professional organisations, civil society, regulatory agency, the Indian Council of Medical Research and vaccine manufacturers should act immediately and allow and encourage enrolment of healthcare workers and vulnerable people in Phase 3 trials. It would enable to quicken a ‘meaningful’ phase-3 trial in India without much risk! They are also the appropriate cohorts to report side reactions with adequate knowledge in the field. This deviation in the enrolment process of Volanteers for phase-3 would go a long way in overriding the virus for ever!

While it is easy to immunise the mass and save the valuable lives in communist Russia or the draconian China, where there is only a little dignity left for human life, it is not so in vibrant liberal democratic republics such as USA, Europe or India for example? Strange, that a ‘sanjeevini’ could be denied in countries that prefer to make noise! Otherwise would we not end up with ‘operation success – patient didn’t survive paradox’?

Credits:

1. https://zeenews.india.com/world/uk-moves-to-fast-track-coronavirus-vaccine-if-safety-tests-passed-2306022.html

2. https://www.thehindu.com/opinion/lead/the-participants-we-need-in-phase-3-trials/article32459266.ece

Could Beirut have escaped…??

The chemicals that went up in flames in Beirut’s deadliest peace-time explosion arrived in the Lebanese capital seven years ago in 2013, on a leaky Russian-leased cargo ship that should never have stopped there. The ship was carrying 2,750 tonnes of nitrogenous fertiliser, which is also a highly combustible chemical, from Georgia to Mozambique when the order came to divert to Beirut on its way through the Mediterranean. The crew were asked to load some heavy road equipment and take it to Jordan’s Port of Aqaba before resuming their journey onto Africa, where the ammonium nitrate was to be delivered to an explosives manufacturer. But the ship was never to leave Beirut, having tried and failed to safely load the additional cargo before becoming embroiled in a lengthy legal dispute over port fees. The captain and lawyers acting for some creditors accused the ship’s owner of abandoning the vessel and succeeded in having it arrested! Months later, for safety reasons, the ammonium nitrate was unloaded and put in a dock warehouse.

On 4th Aug, that stockpile caught fire and exploded not far from a built-up residential area of the city. The huge blast killed 145 people, injured 5,000, flattened buildings and made more than a quarter of a million people homeless. The ship might have succeeded in leaving Beirut, had it managed to load the additional cargo. Confiscation of the goods didn’t lead to recovery of losses but drove the embroiled country into deeper crisis!!

Is it callous attitude of the port authorities that for seven years it was left unattended? What was the regulatory system or such hazardous materials in the country? It can not be hand waved as a one-off incident! There are precedents.

How big was the blast?

The blast destroyed the immediate dockside area, creating a crater approximately 140 metres wide, which flooded with seawater. The warehouse where the initial fire and explosions were observed was completely obliterated and an adjacent grain silo was heavily damaged. Satellite images highlight complete devastation in the port area, with one ship apparently blown out of the water and onto the dockside.

The explosion’s shockwave blew out windows at Beirut International Airport’s passenger terminal, about 9km (5 miles) away from the port. The blast was also heard as far away as Cyprus, about 200km (125 miles) across the Mediterranean Sea, and seismologists at the United States Geological Survey said it was the equivalent of a 3.3-magnitude earthquake.

Ammonium nitrate is widely used as a chemical fertiliser. Why should it explode?

Pure ammonium nitrate is not an explosive on its own. It is classified as an oxidiser under the United Nations classification of dangerous goods. If mixed with ingredients like fuel or some other contaminants, or because of some other external factors, it can be very explosive.

However, for combinations to explode, triggers like detonators are required. Many Improvised Explosive Devices (IEDs) used by terrorists around the world have ANFO as the main explosive, triggered by primary explosives like RDX or TNT. In the majority of terror attacks in India, including those in Pulwama, Varanasi, Malegaon, Pune, Delhi, Hyderabad, and Mumbai, ammonium nitrate has been used along with initiator explosives like RDX.

The prolonged storage of ammonium nitrate can make it suck in water, turning it into a “solid mass.” In that state, ammonium nitrate becomes more likely “to detonate in bulk” than in its granular form. Storage of ammonium nitrate with organic materials — especially liquids that can leak and readily mix, such as vegetable or fuel oil — poses particular risks. Decomposition is an exothermic reaction. If the solid mass gets heated due to that, the entrapped gases can build up pressure. With combustible impurities in the ware house, it becomes an unintended bomb.

The explosion of large storage can happen primarily in two ways. One is by some type detonation or initiation because the storage comes in contact with explosive mixture. Second, the blast can result due to a fire which starts in the ammonium nitrate store because of the heat generated due to the oxidation process at large scale. The second one seems to be the primary likely cause of the incident at Beirut port. There are several documented examples of deadly ammonium nitrate fire and explosion incidents in the past, some with large numbers of fatalities like in China in 2015 and in Texas in 1947.

Credits:

1. https://www.bbc.com/news/world-middle-east-53683082

2. https://www.compoundchem.com/2020/08/05/ammonium-nitrate/

Can Xi win a battle without fighting a war?

Is China’s aggressive posture, a preemptive action to prevent India from any adventure in the PoK theatre? or is to desist India from getting closer to US?

With the successful abrogation of art.370 and reorganisation of J&K, the top BJP politicians have become more vocal and did not mince words to assert India’s legal rights on PoK. The regime has been able to even quell the nationwide ‘sponsored’ protests, which angered both Beijing and Islamabad. It was probably then that Xi felt that if he let Modi continue unchecked, he would have real trouble on the South Western borders of his country and his pet project of China-Pakistan Economic Corridor (CPEC) in PoK, which is a part of the One Belt Road initiative would be at risk.

It is not the first time india’s threat to take over PoK is real; after the brilliantly successful operation in East Pakistan, Indira Gandhi had transferred thousands of troops to the Pakistani border in a bid to take over PoK; It was only a clear warning from President Richard Nixon that perhaps restrained her.

The sharp increase in fervour for Modi-ism in recent times in India is undoubtedly troubling China. Xi strategically decided to give a violent military nudge to the Indian Army in Ladakh in the hope that public opinion would turn against Modi as it had against Pandit Jawaharlal Nehru after the 1962 aggression.

PRC hopes that their friendly parties in India and the left leaning Indian press would do the needed mobilisation of the public opinion to weaken the Modi regime in the height of bloody skirmishes at the border by touting china’s economic and military might. Thus, China’s upping the antenna in the border is essentially to demotivate Modi and his possible gravitating towards a India-US axis in the aftermath of a growing anti-Chinese climate world over.

Xi Jinping, Chinese premier since 2013, under whose regime China’s throttling of human rights and censorship has reached new pinnacle, is no doubt a great strategist! He wants to win a battle without fighting the war.

Against China’s stiff dislike, Would Modi enter into a wider cooperation with group of nations such as G7 or even plan an India-US peace treaty like the one penned by Indira Gandhi with Russians on the eve of the Indo-Pak war that led to the freedom of Bangladesh?

Could Modi be a match to Xi’s perspicacity?

Credits:

https://www.pgurus.com/indo-u-s-defence-treaty-need-of-the-hour/

Would India shirk its Ostrich syndrome at least now?

Prime Minister Narendra Modi, the other day, assured the nation that the sacrifice of Indian soldiers killed in a clash with Chinese troops at Galwan Valley in Ladakh would not go in vain and India is capable of giving a fitting reply if provoked.

Mr Namgyal, the Ladakh member underlines the Modi’s statement: “The government today is not the same one as in 1962. What Prime Minister Narendra Modi says, he does. Before the surgical strikes he had said the same line”.

Would this escalate into a war? A big NO, of course.

In the last four decades, China adopted the formula of “the supreme art of war is to subdue the enemy without fighting”. It has resorted to area expansion and domination tactics using numerical superiority and military aggression. It continued to nibble away at our territories through aggressive patrolling and continuous border violations. In the last one decade, more than a thousand such border violations have been recorded. That there have been no violent clashes between India and China in the last five decades can be partly attributed to India’s insistence on diplomatic engagement and physical disengagement. During this period, the Chinese side had gobbled up Indian territory in several places.

But the present imbroglio would not end as a repeat of earlier ones; Experts assert that though there will not be a full scale war, nevertheless de-escalation in the near future is very unlikely.

Yet, there would be a proxy war that would be fought off the border! it may prove to be a watershed moment in the existential battle between Beijing and Washington! How?

The Chinese are keen not only to deflect the bad global press they have got after their shoddy handling – either by default or design – of the coronavirus outbreak. This coupled with the situation in Hong Kong has made the Chinese leadership look bad in the eyes of their own people (who have access to global news) and their vast diasporas across the world.

Trump’s US-China trade war has sharply affected Chinese jobs and incomes in a situation where consumer prices are already high in the PRC and rising. The steady de-coupling of the US, Japan and other countries from China has led to price instability and job losses in the world’s second-largest economy. US strategy is to steadily slow down the economic growth in China to ensure a USSR-style meltdown in the PRC.

Apart from the worries created by trade frictions, as a consequence of the Great Lockdown Strategy around the world, the Chinese economy is being battered by the shrinking of demand for its products by the global economic collapse.

Thus there is a need for the Chinese leadership to do muscle-flexing either in the South China Sea or the unsettled boundary with India, more so as India shifts steadily closer into the American camp and the ‘Quad’ of nations that also has Japan and Australia other than US and India. To restore its credibility, CPC is compelled to play to the gallery of domestic audience and its international diaspora! Should it backfire, one would not be surprised if Xi falls!

In this do or die proxy battle, though Moscow is firmly on the PRC side, it is imperative that India take openly the side of USA in international arena of cooperation not withstanding the long term military relations with trusted Russians.

It is high time that India at least for now abandons its age old Lutyens failed policy of playing the ostrich while the two superpowers, China and the US, are in logger heads to outwit each other!

Credits:

https://www.sundayguardianlive.com/news/india-may-re-evaluate-neutrality-us-china-war

Asses and Horses

Very catchy headlines by congress stooge NDTV; ‘RG roasts centre’! Only ‘HINDU’s and NDTVs can prop up this imbecile who has only recently donned the role of a ‘sincere student’ struggling to get educated interviewing learned laureates, after crossing the ‘middle age’.

Some wise adviser has given him the right script with wrong conclusions; “India’s failed lockdown: Compare with the west. Picture Perfect lockdowns – clamp when the cases are increasing and release when it slows down; For reasons known only to ‘Modi’ and his managers, the lockdown is released when even RG could not sight the downtrend such as the one he saw in Italy! Had he been the PM (or MounSingh as his dummy), RG would have waited an opportune time to emulate the Italy model to unlock”.

OK. Let us get into the brass tacks – The peaks were quickly realised in those countries that have been compared since the rate of rise of the cases were too quick (the doubling times were shorter); incidentally, a plot of number of deaths could have cleared the sky; lockdowns are intended to flatten the curve or decrease rate of rise and save lives; the progressive easing of lockdown and allowing movements (buses, private vehicles, trains and domestic air travel for example) are bound to disperse the spreaders however tightly the lockdowns are; consequently the number of hot spots would have increased. This is an inevitable consequence to balance the pain of losses in economy and mortality!

One should not lose sight of the fact that, every single big state in india in itself, can be considered with any of the country in these graphs. Now the cases are mainly concentrated only in three metros: Mumbai, Delhi and chennai. Even the ‘migrants’ haven’t impacted the stats that much in their native states can be an outcome of benefits of the lockdowns. The country cannot withstand the economic impact of lockdown for more than two months. Once the health infra is beefed up and most of the citizens were trained to confront the monstrous virus, with the required respect, during the slowing of progress of infection, the unlocking was initiated.

Why is the peak eluding? In my opinion, the reluctance of public in divulging their contacts and resistance in isolating themselves in these rogue cities, are the reasons for not realising the expected droop in the ‘plot’. It is also extremely difficult to enforce the required personnel distancing and societal hygiene in these densely populated rural segments of the metros: it is indeed an epidemiologist’s worst nightmare! These cities had origins of this infection with the seeds sown far and wide from the infamous ‘Delhi’ meet involving ‘infected foreigners‘! Unfortunately, the ‘infected natives‘ could not be constrained effectively when they reached their abodes, as there were widespread animosities and misunderstanding. In other words there were effectively ‘no lockdowns’ in these cities till date.

One can easily see the fruits of the ‘pain’ in the rest of the country; even Gujarat, MP, UP, Punjab have been tamed; Karnataka, Kerala, Bihar, Orissa, AP, Telangana, Assam have always done better. It is appropriate to Compare the stats of these states with the likes of Italy, Spain, Germany.

It is my strong opinion that prolonged lock down and progressive unlocking in india is a model by itself for emulation for the rest of the world. It is neither as draconian as that of China nor has an uncertain mindset of UK. There were no chaos like in the ‘civilised’ US against the restrictions in this vast, vibrant and vocal democracy!

One can only be too ignorant to compare asses with horses!

Credits:

https://www.ndtv.com/india-news/coronavirus-rahul-gandhi-blames-centre-for-a-failed-lockdown-with-5-graphs-2241524

Would we ever know the truth?

The gravity of the infection, in Wuhan city, Hubei province, was realised in the third week of January 2020; the number of cases swelled from 300 on 21st Jan to 30000 by 4th Feb, that is roughly 100 times in 15 days, a doubling time of around 2 to 3 days!

On 23 January 2020, the central government of China imposed a lockdown in Wuhan and other cities in Hubei. The lockdown in Wuhan set the precedent for similar measures in other Chinese cities. Within hours of the Wuhan lockdown, travel restrictions were also imposed on the nearby cities of Huanggang and Ezhou, and were eventually imposed on all 15 other cities in Hubei, affecting a total of about 57 million people. Ever since Hubei’s lockdown, areas bordering Hubei including Yueyang in Hunan and Xinyang in Henan set up checkpoints on roads connecting to Hubei to monitor cars and people coming from Hubei. Between 24–25 January, the local governments of Shanghai, Jiangsu, Hainan and other areas announced to quarantine passengers from “key areas” of Hubei for 14 days. Many local governments implemented restrictions to control the outbreak, including keeping schools closed, cutting off villages, and restricting travel. A smartphone-based health-tracking system was introduced in much of the country for easy and quick contact tracing.

May be Taiwan was the first country to bar immigration entry from mainland China on 25th Jan Other countries followed.

The infection was contained mostly within the Hubei province of 59 million population; Total number of cases amounted to 68160 (1100 per million) with total deaths at 4512; The mortality is around 7%.

With this background information let us try to resolve the China conundrum:

1. The rest of China had substantially lower number of cases, only 14759 with total deaths accounting to only 121. Considering the speed with which it spread in Europe and US, the numbers from China are unbelievably small!!

Chinese claim that, since they knew the infection originated from Wuhan, early containment measures could be effectively taken that contained within a city;

Still, the markedly lower infection in other provinces, seems pretty odd! Whether China is right in claiming lack of adequate administrative containment measures, by other countries as the reason for the spread of this killer virus!

Or Could there be deliberate cover up and under reporting?

2. Also, It appears a near impossible task to restrict the spread considering a similar, rigorous curfew cum lockdown experience in India! At that time the infection in india may not be more than few hundreds. But In India the infection is now present in most of the major cities unlike in China!

Could it have already spread its tentacles before the announcement of lock down in India? Curious!

3. The total episode of the virus pandemic spanned from Jan 21st to April 8, only around 75 days in Wuhan, from detection to contamination free status; but in India, even after 60 days, cases keep mounting neither peak nor any respite in infection is noticeable. Why? Is it because india is under a democratic and not a communist’s lockdown?

International communities should discuss threadbare the different experience with China and find an answer!

4. How far one can rely on China’s published data: even the number of cases reported shows some two isolated peaks one on 14th Feb 15192 and the other on 15th Feb – 5090, the neighbouring data points generally being closer to 3000! There were also reports of miscounting of number of deaths!

Are they just reporting errors or is it part of an elaborate and deliberate cover up?

5. While strict measures were enforced early enough, that is by 21st Jan, to contain the infection within Wuhan city, and may be within Hubei province, why travel advisories were not issued for emigration to foreign countries? Different strategies for containing the local spread ignoring export of carriers abroad!

Is it a deliberate oversight to underplay the gravity of the ‘endemic’ (at that point of time)?

6. There are reports of intimidation of independent investigative reporting! Leave the pressure applied on the ophthalmologist, demanding his public apology for spreading rumours, while in fact he rightly suspected ‘SARS’ like infection in his patients (as early as in late Dec 2019) and shared this information with his colleagues!

Could there be any substance in these rumours?

There appears to be more than that meets the eye in this China story, that is for sure, even for a layman! Could there be heavy under reporting?

Could vocal Trump be right in suspecting China of nefarious act? Prima facie yes!!

Credits:

https://en.wikipedia.org/wiki/COVID-19_pandemic_in_mainland_China

Eves lead successful battle against Covid-19

As the world is grappling with the coronavirus crisis, women leaders of some countries, have outperformed even developed nations like the United States, Italy, and China in the fight against the novel coronavirus. Plenty of countries with male leaders – Vietnam, the Czech Republic, Greece, Australia – have also done well. But few with female leaders have done badly.

Germany, led by Angela Merkel, was quick to institute a response and one of the first countries in Europe to fast-track testing. With a doctorate in quantum chemistry, Merkel’s clear, calm expositions – a clip of her explaining the scientific basis behind the government’s lockdown exit strategy was shared thousands of times online. 171K cases and 7500 deaths.

Taiwan, led by President Tsai Ing-wen, and with an epidemiologist as her Vice President Chen Chien-Jen at her side, has been one of the rare countries to successful stop the spread of coronavirus in its tracks without the mass disruptions to daily life at the level seen in most other countries. In all, Taiwan adopted 124 control and contain measures in weeks, making a full lockdown unnecessary. Just 440 cases and 7 deaths! This island nation is now dispatching millions of face masks to the worst-struck parts of the US and Europe, though many have not recognised this nation!

New Zealand, led by Prime Minister Jacinda Ardern, chose to “go hard and go early”, and imposed a 14-day quarantine on anyone entering the country on 14 March, implemented a strict lockdown two weeks later and conducted extensive tests. When some flouted the restrictions imposed by the authorities, the Prime Minister chastized them to “apply common sense”. Now the country succeeded in total elimination of the coronavirus with 1497 cases and just 21 deaths!

Denmark, led by Prime Minister Mette Frederiksen, was one of the first countries in Europe to shut down its borders and to put the country in lockdown early. That decisiveness appears to have spared Denmark the worst of the pandemic, with 10K cases and 529 deaths.

Norway, this week began relaxing its restrictions by reopening kindergartens. The prime minister, Erna Solberg, told that she had made a point of “letting scientists make the big medical decisions”, adding that she thought her country’s early lockdown and thorough testing programme had been key. 8K cases and 219 deaths.

Finland’s prime minister, Sanna Marin – who last year became the world’s youngest head of government – also moved decisively to impose a strict lockdown, including a ban on all non-essential travel in and out of the Helsinki region. This has helped her country contain the spread of the virus to just 4,000 cases and 140 deaths, a per-million toll 10 times lower than that of neighbouring Sweden.

Iceland, under the prime minister, Katrín Jakobsdóttir’s, leadership, offered free testing to all citizens, not only those with symptoms, has recorded 1,800 cases and 10 deaths. Some 12% of the population has taken up the offer, and an exhaustive tracing system has meant the country has not had to close schools. 1801 cases and 10 deaths.

Not only the women excelled in the corona crisis are national leaders, Jeong Eun-kyeong, the unflappable head of South Korea’s centre for disease control, has become a national icon after overseeing a “test, trace, contain” strategy that has made the country the world’s coronavirus role-model. Jeong, a former rural doctor dubbed “the world’s best virus hunter”, has delivered no-nonsense daily press conferences, including demonstrating the ideal way to cough.

South Korea, which in early March had the second highest number of cases globally after China, has been able to control the virus spread without having to take severe measures such as imposing a lockdown or banning overseas travel. Instead authorities have relied on a massive testing and tracing regime. 11K cases and 256 deaths.

If Kerala, a small state in India with a population of 34 million, could contain limit the total number to just 520 with 4 mortalities, the credit should largely go to KK Shailaja, the state’s health minister, affectionately called Shailaja Teacher. Not only is her work with Coronavirus efforts commendable, she has a history of taking crisis head on: In 1981, When Kerala witnessed 21 deaths of the 23 patients who got infected in a single district, it managed to contain the spread of Nipah, which has a case fatality rate of 40 to 75% (as compared to 3 to 4 percent for coronavirus); took strict actions like quarantining over 2000 people suspected of being infected in and actively tracing people who may have come in contact with infected persons. Shailaja says, “Fighting an epidemic like corona requires scientific temper, humanism and a spirit for inquiry and reform. Superstition, credulity, emotionalism and irrationalism will derail the whole process by dispiriting and discouraging the experts and health activists who try hard to resolve the threat scientifically.”

Eves win hands down, Adams may emulate!

Credits

1. https://www.theguardian.com/world/2020/apr/25/why-do-female-leaders-seem-to-be-more-successful-at-managing-the-coronavirus-crisis

Doomsday calling?

Don’t sit back and relax thinking that we have outsmarted the virus that played havoc in the west! No. The story might have just begun; the painful and draconian lock down has in deed provided the much needed time to prepare the population mentally, equip the paramedical facilities and reach nearer to the timeframe of a viable therapy or vaccines if at all made available or wait for some miracle!

From the present mortality rate of 0.14% among the tested population, and the data available so far (with the lock down constraint) some future projections can be made:

Assuming the general population has more immunity and the general physical distancing measures are adhered to even after completely lifting the lock down, one can’t get better than 1/10th of this mortality rates, that is 0.014% or 3 deaths per 20000. This works out to roughly 1.8 lakh deaths for the whole population to get infected; or half of it for 50% to get infected and achieve the herd immunity (based on the experience of various immunisation programs), which means 0.9 lakhs death! Ok. But when?

Presently 50K have been infected and 10 days is the doubling time. Even if the doubling time becomes 20 days, by the end of two months, only 4 lakh would be infected, that is July.

By sep 32 lakhs… and so on, if this races in this speed, 256 lakh by nov, 40 crores by Jan. that is almost nearer the target for herd immunity. That is, in this scenario, around 90K deaths in the whole country by Jan 2021.

If we achieve herd immunity with 1/4th population optimistically, even then the death will be an astounding 45K which we would reach by Dec!

There is no absolute way of modelling, the whole projection is riddled with lots and lots of assumptions. Mine is the most optimistic scenario as of today. Rest assured, that these numbers must be haunting the minds of the mandarins managing the outbreak menace!

Should there not be some out of the box thinking – such as open to other systems of medicines in a big way? It is certain that the allopathic system has raised its hands already with excuses! Man once believed that he is invincible with lots and lots of understanding of human anatomy and medical therapies!

If the virus chain gets completely broken and the those entering the country are monitored with utmost vigil, then the doubling time can substantially increase; this may not be entirely impossible. Or some miracle should happen, like its committing suicide, with no remnant virus strain with anybody except in the labs, the virus would have its hay day at least upto the end of this year – by the way, who wished you happy new year – 2020?

Sit back and enjoy getting raped – watch the Cosmic dance or vandalism of the virus – whatever you wish to call this ‘fiasco’!