Categories
Public Health

Covid19 – Data shows happy days will have to wait…

Lockdown 2.0 was supposed to get over today. Unfortunately, Lockdown 3.0 has been announced and we are now sitting at the cusp of 40K cases. We have gone from 20K cases to 40K cases in less than 2weeks, whereas the first 20K cases came in 2.5 months. Various states are showing a spike in cases, while new states are showing some disturbing trends. Is this the explosion that we were waiting for? Are we on the path of the US and Europe?

We look at the data and try to form a picture of the situation of India. We also take a look at the Indian States in clusters of the Encouraging States, the Worry States and the Emerging Bad. We also use CPM19 to see if we can predict how 17th May 2020 may look like for India.

Recovery Rate Update

We had introduced the recovery rate as a new parameter in our last article. In the 10 days that have passed since our last article, let us look at the recovery rates now. Green means improved from the last article and red means deterioration from the last article. Yellow means no significant change.

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Except for Spain all countries have either improved their recovery rates or stayed the same. France continues to recover poorly.

India With the World

India is on its 49th day after the 100th case. The 7 day rolling average of the growth rate for the country is 5.95%. When, compared with other countries studied it is the highest among all countries on their 49th day (See table)

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India, has clearly not followed the 42 day theory. To counter this we hypothesized that India should be treated as an amalgamation of several different countries. Hence, we broke India in 7 different parts basis cases reported. Maharashtra, Delhi, Gujarat, Madhya Pradesh, Uttar Pradesh, Rajasthan, and Tamil Nadu were taken separately and assumed to be a separate country. The remaining states were considered as ROI. When we look at it in this format, most of the states with a high number of cases are still at least 9-10 days away from the 42-day mark, except Maharashtra.

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As, it can be observed by the above table, most of the states are considerably slower than the other countries in the study as on that day. Even Maharashtra is slower than USA on the 40th day. ROI which is on its 45th day is also on the cusp of crossing below the 5% threshold. ROI had crossed the 5% threshold on the 42nd day but due to emergence of cases in Punjab it has gone above the 5% threshold again today.

India and Its States

In previous articles we had identified clusters of the state as

  • The Worry States – These were the states that had shown high growth in lockdown 1.0. These states were Delhi, Gujarat, Madhya Pradesh, Maharashtra, Rajashtan, Uttar Pradesh and West Bengal
  • The Encouraging States – These states were those that had shown signs of slowness in lockdown 1.0. These states are Andhra Pradesh, Harayana, Karnataka, Kerala, Tamil Nadu and Telengana

In this article we introduce a new category

  • The Emerging Bad – These states have shown sudden spurt of cases in lockdown 2.0. These states are Bihar and Punjab.

The Worry States

The Good news is that all the “Worry States”, 7 day rolling average of growth rates has now come below 10% (See Graph). The bad news is that even at this rate these states will continue to add somewhere between 1500 to 2000 cases daily.

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As you can see in the graph, states are showing trends of slowing down with UP and Rajasthan seemingly going below 5%, but until states like Maharashtra, Gujarat and Delhi come well below 5% there is little hope of a slowdown in these “Worry States”

These states are characterized by

  • High Positive% – The Positive%, which is total cases upon total tests is very high for these states. Except for UP and Rajasthan, the positive% is higher than 4% (the national average). Maharashtra and Delhi have a positive% higher than 7%
  • Low Outcome % – Only 26% of the cases have seen an outcome in these states. Outcome means that either a recovery or death has happened in that particular case. This is lower than the national average of 30%
  • Low Recovery Rate – The recovery rate is 86% which means in these states out of 100 outcomes, 86 people recovered. For states like Gujarat, Maharashtra and West Bengal it is lower than 80% which means that for every 4 people who recover there is one death.
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We will keep a watch on these three parameters to see if they improve over time.

The Encouraging States

Most of the states are now well settled under 5% growth rate except for Andhra Pradesh and Tamil Nadu. Andhra Pradesh also seems to be moving towards the 5% mark. Tamil Nadu is one blip on these states as after being well below 5% for a while it has now started moving up and has broken the 5% threshold. Tamil Nadu will be the state to watch

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These States are Characterized by

  • Low Positive% – Most of the states are well below 2% except Telangana and Tamil Nadu. Telangana also might be an aberration as the state has not updated its test numbers since 29th April.
  • High Outcome% – Almost 50% of the cases have seen an outcome in these states. Except for Andhra Pradesh, almost all states have an outcome% higher than 50%
  • High Recovery Rate – All the states have a recovery rate in excess of 90%. This means for every death in these states there are 9 people who recover. Kerala and Harayana infact are almost at 100% recovery rate.
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The Emerging Bad

Bihar and Punjab have shown growth trends in the past seven days that has motivated us to look at these states closely

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These states have a poor outcome%(this is because recency of cases) , although they seem to be doing okay with respect to recovery rate and positive%. These states will be monitored closely

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17th May 2020 – Where will we be?

The lockdown continues till 17th May 2020 albeit with some ease in restrictions. With economic activity starting again, the situation does not look like improving in the next two weeks. Using CPM19 we have tried to make some predictions as to where we might be on 17th May.

Although our daily growth rate will go down below 5%, but in terms of cases reported we will be hitting a peak by 17th May.

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Total cases according to the CPM19 Model will hit 75K. Our exponential growth curve would have started flattening but as of now it seems it will flatten only after reaching 100K cases.

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We have been in lockdown now for 40 days. In these 40 days we have ensured that we dont have a situation that overwhelms our medical system. But we have also failed to flatten the curve. At this juncture, if we see another exponential growth then Indian numbers will be very high and will probably end up going well past Europe by end of May. Instead of easing lockdown, the need of the hour is for a more stricter lockdown. Easing will just increase cases. Also as temperature is not playing any role in stopping this pandemic, India faces some tough days ahead.

On a brighter note, India seems to recovering well from the Covid19 with high recovery rates. If this trend continues then we may have a situation like Germany, high infections but low mortality rates. All we can now do is to try to stay as safe as possible because the next few days are going to be very risky.

About the Author

Sanjeev Prakash is an Analytics and Marketing professional with more than 12 years of experience in Analytics, Data Management, Sales, Brand Management, Corporate Communications, Market Research and Customer Relationship Management. Sanjeev has an MBA from IMT Ghaziabad and a degree in economics.

Categories
Public Health

Good, Bad and Ugly of COVID 19

By Kiten Meena

Change is difficult for all not only human. If you look back in human evolution you will find survival of the fittest. Change is never easy whether it is at work or at life specially when it is thrown at us without our buy-in. Many of us did not see COVID 19 coming. Hence, the resistance to accept the change it brought in our lives.

You have two choices – accept the change and find peace with it or rebel and go through the consequences.

Let’s start with good. The lockdown has brought us closer to our loved ones. I for sure have thought, what if these were my last 30 days of my life? What kind of legacy I want to leave behind? I want to be remembered as the perfect mother, a decent housewife, a great daughter, a helpful colleague and a best friend. Now, I have more time to spend with my family and loved ones. No more running Monday to Friday and then Saturday and Sunday to check off the list. COVID has taught me and reminded me of Mother Teresa and Mahatma Gandhi, Can I live a simple and peaceful life with bare minimum? Probably, we all could. Hence my request to look around and find happiness in what you have, what you have achieved and how you can help the needy or next-door neighbor. Once you accept the change you will find the ways to make best of it. Though it’s not easy, it is doable.

During such times, we are tested for our patience, endurance and adaptability quotient. At work, I have been asked to do more and better. As a working mom at home, it is quite challenging, when I feel, I am on the verge of breakdown. I look at my sister or friend who work at hospital. When we are locked down, she still had to go to work, risk her life and her loved ones to make life better for someone else. I find myself ashamed of not able to take this on. When my fellow nurses and healthcare staff going to much more than any of us are doing at home in our own comfort and away from sick and unhealthy. Imagine yourself in their shoes and you will find yourself – wearing masks and taking precaution, not only for you but all those brave souls who are risking their lives.

That’s not all, if you look closely you will find the worst affected ones – the small shopkeeper or hourly wages folks who barely had ends meet before COVID 19 and now struggling to survive each day. If you could just see past your uncomfortable zone, someone who lost family member to COVID 19 with no fault of their own. The anguish, pain of the young fellow who lost his job to COVID 19. Small business owners with loads of loan to pay and no hope of getting anywhere in near future. The mental state of such a human being at the verge of suicidal.

I found myself blessed and I want to share the joy I have with my kids, my family, friends and you readers. Reach out to your old friends whom you always thought of calling and never had time to make that call. Locked down in your own house is not easy for any of us but we can still do meditation, yoga, stretching to make ourselves ready for what’s coming next. Keep that hope alive, pass that unused food and items to the next-door neighbor.

Each drop of water counts – makes a difference. When you will look back after 10 years from now and recall COVID 19 – you should have a smile on your face and be proud of yourself.  Until we find cure or vaccine to control COVID 19, my fellow friends I plead you to do your best to beat this – by keeping social distancing, wash hands, cover your face with mask and avoid gatherings. COVID 19 makes me find myself and taught me to accept today and enjoy it to the fullest as future is unknown for a short while.

About the author

Kiten Meena

A result-driven, enthusiastic healthcare professional with years of experience in healthcare information technology in the successful delivery of critical and strategic projects. The initial few years spent honing my analysis skills and building healthcare products.

Kiten has extensive experience in working with healthcare delivery, clinical optimization, health plans along with healthcare regulatory and compliance projects. With a Master’s in Healthcare Administration from the University of Southern California Sol Price School of Public Policy – I am interested in taking up challenges and work in patient care settings to improve the overall healthcare experience for all.

Categories
Public Health

Covid19 the real path to recovery

Since our last article, new Covid19 cases have started showing a declining trend in the countries most affected by the virus. India, on the other hand, has started showing a disturbing trend. The ‘42 day theory’ has held true for all the countries under study (except S.Korea, an outlier). Will it hold true for India or will India also be an outlier to this theory?

With declining new cases, the recovery rates and the mortality rates start to come in play. Countries that we studied are all exhibiting different recovery rates. What factors influence recovery rates? Do some countries have an advantage over the other?

India has also crossed 20K cases. Are the same states still contributing to Indian cases or are there new states with high growth? 

These are some of the questions we will try to answer in this article with the data that is available with us. And finally we will look at this week’s performance of states that we had identified as “Encouraging” states and “Worry” states in our last article.

But first we look at the CPM19 model Performance

CPM19 – On the Mark

The model has now caught the trend of all the 9 countries in study and for the last 3 days it has been predicting with almost 0% error.

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The significance of this is that now we are able to predict daily growth rate and extrapolate the growth rate for the next 10 days with little error. We used this to look at the next 7 days for the countries in study and it definitely looks like all of them are on the path to recovery, except India.

The 42 day Theory – Update

In our last article, we had postulated the 42 day theory. (Read it again) All but the USA, India and Sweden had gone below the 5% threshold as on last update.

USA – US was on its 45th day and we had predicted it will go below the 5% threshold on the 48th day. It went below the threshold on 48th day

Sweden – Sweden was on its 41st day and we had predicted it will go below the 5% threshold on the 42nd day. It went below the threshold on the 42nd day.

So, for the USA and Sweden, our predictions were right on the mark. Also, we had postulated that once any country goes below the 5% threshold on a 7 day rolling average, they really slow down. That theory also seems to be holding true. (See table)

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Except for Sweden which showed a slight increase on one day, all the other countries have shown a steady decline in their daily growth rates over the last week.

Unfortunately, the theory does not seem to be holding true for India. India is on its 38th day and with the current daily growth rate of India, we do not see India going below the 5% threshold till day 50. We are unable to predict beyond the 50th day for India as India has shown erratic trends recently.

On the 38th day, India stands 3rd behind USA and France in terms of seven day rolling average of the daily growth rate. With the trend seen in the graph India might breach the max mark.(See graph)

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The Recovery Rate

Different countries are showing different rates of recovery, even though they may be on the same life cycle of the virus. We looked at various parameters to see if we could identify the reason for difference in recovery rates. 

To begin with, let’s define recovery rate.

Recovery Rate  = Total number of recoveries / Total number of outcomes (death + recoveries)

We analyzed correlations between various parameters and recovery rate. We also checked the correlation of these parameters with the average daily number of cases reported after the 100th case. 

Parameters Studied

Test/Million – We looked at test/million as the first factor that may aid recovery and also may explain the number of cases. Surprisingly, test per million parameter had very poor correlation with number of cases and negligible correlation with recovery rate

Obesity Rate – We looked at the obesity rate of the country that is percent of people in the country who are obese. This had a strong positive correlation with the number of cases. This means that higher obesity rate resulted in a higher number of daily cases. There was also a moderate to weak negative correlation with recovery rate. Higher the obesity rate, lower was the recovery rate.

Overall Population Age – Average age of the population had no correlation with either recovery rate or cases reported

Percentage of population infected over 50 – Since age had no correlation, we looked at the percentage of infected out of total infected, that were over 50 years. This showed a strong negative correlation to recovery rate. If the percentage of infected over 50 years out of total infected was less, the recovery rate was higher

T Factor – We looked at the amount of tourists that visit the country. Our hypothesis here was that a popular tourist destination would be more susceptible to the infection. We indexed the tourists basis the total tourists that visited the country in 2019 and called it the T factor, This showed a strong positive correlation to the daily number of cases reported

CD Factor – We also looked at the Chinese Diaspora. We hypothesized that a higher Chinese Diaspora would mean more travel of infected population from China to that country, both business and tourist. This also has held true as there is a huge positive correlation between CD factor and daily number of cases reported

We take a look at the impact of these factors for each country. 

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India

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India is green or light green on all the parameters except test/mil. This clearly shows in the recovery rate. India needs to take care that its %infected over 50 does not increase. 

Also India’s total outcome percentage that is total cases that have had an outcome over total reported cases is very low (23%). So the recovery rate may fluctuate.

Italy

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Italy has a medium obesity rate and high T factor along with a moderate CD factor. Italy is also a favorite destination amongst the Chinese. This was one of the factors for initial infection. The fact that 71.2% of its infected cases are above 50, it has a low recovery rate also

USA

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USA has a high T and CD factor. Combined with the high obesity rate, it has the highest number of cases. Also the high obesity rate and 50% of infected people being above 50 has led to its low recovery rates. The outcome percentage for the USA is only 16%. We still await results in 84% of the cases

Iran

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We did not have the age of infected people in Iran so could not review the recovery rate versus age. Iran has low T and CD factors, however, we know from news report that the initial infections in Iran were from closer interactions with China, that rose exponentially because of a religious event in the area of the outbreak.

South Korea

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South Korea is the anomaly in our study with respect to Per Day Cases. South Korea has both a high tourist population from China and a huge Chinese Diaspora. But proper management of people inflow from China helped control the spread in initial days, though they did not ban travel from China. The latter increase in cases were attributed to patient 31 who was a super spreader. The source of that infection has never been identified but post that Korean administration did well to control the spread with aggressive contact tracing.

Spain

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Spain also suffered a lot in the initial days of the outbreak. However it was able to stabilize the growth rate. With a high obesity rate and a high T factor it has reported moderate per day cases and its recovery rate is also moderate. This is due to a high percentage of infections being reported in those above 50. Also 49% of the cases still are awaiting outcome, so the recovery rate may fluctuate.

Germany

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Germany has had the fifth highest cases worldwide. Most factors were poor or moderate. This has meant that Germany though has reported a higher number of cases has managed the infection well amongst the elderly. Infact, Germany was lucky as the infection came in the country through youngsters holidaying in Italy. Rigorous testing ensured that the asymptomatic cases were also identified so that they were not able unknowingly to spread the infection amongst the older population.

France

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Due to a high T factor and its popularity amongst the Chinese, France has seen high per day cases. It has a low recovery rate also as the majority of infections are amongst the greater than 50. Outcome% for France is also low at 38% so there could be an impact on the recovery rate.

Sweden

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Everything was in favor of Sweden, except the fact that it has a moderate obesity rate and it has let the infection spread amongst the elderly. It has the poorest recovery rate and the outcome% is also very low so that recovery rate may further worsen. Sweden’s main concern is the spread of infection in old age homes.

With only 34% of the cases that have had an outcome, this might be a little early to be looking at recovery rates but this gives us a direction of things to come. We will continue to track recovery rates across countries.

India – 20,000 and beyond.

India has become the 17th country to go beyond the 20K mark. It has crossed that mark almost after 3 months since the first reported case. Let’s take a look at the daily growth rate of new cases after India reported its 100th case.

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Although the trend is downward, it is not a rapid downward trend which is not resulting in a slow down for growth rate. India’s problem seems to be arising from the fact that new states keep emerging as growth drivers while not enough states seem to be slowing down. 

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We looked at which states contributed the most in the first 10K cases and then in the next 10K cases. While Maharashtra remained top in terms of contribution, Gujarat, MP and UP have taken over the top 5. These states are also growing at a much faster pace than even Maharashtra.

Story of the States

The Worry States

In our last article we had identified states that were a worry or were showing worrisome signs. The graph below shows their 7 day rolling average of daily growth rate since the last update

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The good news is that Delhi has definitely slowed down and the growth rate has now gone below 5%. Rajasthan is also showing some slowing trends as the growth rate has just gone below 10%. 

Gujarat, MP, UP and WB are the major cause of concern currently. All these states are trending higher than Maharashtra. Although, Maharashtra is slowing down its not slowing down fast enough. Since a high number of cases have already been reported in Maharashtra, a 10% growth rate also means around 500 to 600 cases daily in the current scenario.

Encouraging States

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The empty space above 10% tells the story here. All these states have now come below 10% and have stayed below 10% over the last 7 days. Haryana has joined Kerala in the below 5% club of 7 day average growth rate. Tamil Nadu also seems to be following suit. Karnataka and AP are two states that also need to slow down and get below 5%.

India’s Road To Recovery 

The road to recovery is highly dependent on the UP, MP, Rajasthan, Gujarat, Maharashtra and WB. 

These are also the most populated states of India. Except Rajasthan, they are showing a growth rate in excess of 10%.

Extreme poverty in these states means that they also have a huge migrant population.Residents of UP, WB and Rajasthan travel all around the country as migrant laborers which will put all the other states which have controlled the cases during the lockdown at risk. 

Daily wage workers form an important part of our agricultural and infrastructural economy, keeping them under lockdown for a longer period will also be detrimental to our economy. 

Unless these states show dramatic improvement May 3rd does not seem enough for India.

About the Author

Sanjeev Prakash is an Analytics and Marketing professional with more than 12 years of experience in Analytics, Data Management, Sales, Brand Management, Corporate Communications, Market Research and Customer Relationship Management. Sanjeev has an MBA from IMT Ghaziabad and a degree in economics.

In Collaboration with Parinay Pande

(Also published on LinkedIn https://www.linkedin.com/pulse/covid-19-real-path-recovery-sanjeev-prakash/?trackingId=4oI3Xc4ESvOb3m%2FU%2B2jOcw%3D%3D)

Categories
Healthcare Delivery

Working towards a Lean Healthcare system

With the increasing emphasis on the application of concepts of lean management in hospitals across the world, gaining popularity as ‘Lean Healthcare’, Value Stream Mapping (VSM) is an elementary tool that allows one such implementation. The common principle behind lean management is ‘to do more using less’. The VSM model is particularly designed for hospitals and healthcare settings that have a direct influence on the admission of patients and their time of treatment. This article presents a case study of a tertiary care hospital of India where the ‘Lean transformation-VSM’ of the ‘Patient-admission’ process is administered for the reduction of time taken by the admission process. Efforts were made to reduce the admission of the patient for making the process smoother and faster when compared to the existing process in the hospital.

The first step involved in the experiment was to gather information of existing patient admission process followed in the hospital by: Direct observations, Interviews and Patient follow-ups. A comprehensive study of the patient admission operations was accomplished, which was later successfully utilized to recommend improvements to reduce delays. Analysis of the existing state was done using a ‘time-motion study’.

The non-value-added steps were identified in conducting the ‘Root-cause Analysis’ of every step involved in the patient admission cycle. A new process was designed by syndicating them, streamlining or reviewing the categorization of events to support greater competency or even discarding few steps. Efforts were made to implement the ‘Modified value stream process map’.

The result was astonishing! The entire experiment helped in bringing down the time of whole process of admitting the patients from an average of 25 minutes per patient to 15 minutes per patient. The hospital was able to achieve almost 40% of reduction in overall patient’s time for their admission process. This in turn offered the hospital with the earnings of higher patient satisfaction.

The understanding of recreation and the steps involved in conducting this recreational study built a strong groundwork for verifying and validating the simulation model-VSM.

John F. Kennedy said ‘We must use time as a tool, not as a crutch’. Efficient optimization with the help of Lean Management can enhance not only the operational efficiency but also the quality of care provided to the world. The experiment was just a drop into the wide oceans of Lean!

About the Authors


Dr. Feroz Ikbal
Assistant Professor,
Tata Institute of Social Sciences Mumbai campus
EmailID: feroz.ikbal@tiss.edu


Dr. Megha Jogi
Master of Hospital Administration (MHA),
Tata Institute of Social Sciences Mumbai campus
EmailID: meghajogi9@gmail.com
With the increasing emphasis on application of concept

Categories
Public Health

Covid19:A few myths about the virus

The world is grappling with the stark implications stemming out of the uncontrolled coronavirus pandemic. Healthcare infrastructure is under severe stress. Precious lives are being lost in large numbers (over 143k fatalities so far). Economic fragility is peaking, unemployment rate is mounting, and supply chain breakdown is hurting millions across the globe. With no sign of cure or vaccine being available in foreseeable future, nations are deploying strict and discrete measures to arrest the impact of this unprecedented crisis.

In this digital age, populations are benefitting from the constant flow of information related to covid19. Social media and instant messaging platforms are buzzing with videos, memes and trending hashtags, print media is being flooded with opined articles and by-liners from pundits, and news channels inundated with harried correspondents trying to bring every piece of information at your fingertips is quite common.

However, it becomes an arduous task for an individual to sift authentic and trustable information from the copious stream of content. As a result, a myriad of myths related to coronavirus has surrounded all of us. These myths incorporate multitudes of aspects connected to coronavirus – etiology, symptoms, vulnerability, treatment by home remedies, drugs/vaccines available, food habits, immunity boosters, effect of weather on virus potency etc. – which could be equally dangerous as the coronavirus itself. In a recent incident in Iran, more than 600 people died from the consumption of high-concentrated alcohol based on a rumour that it could prevent infection from coronavirus. The severity of these misplaced myths/fake news about the hazardous cures and viral hoaxes can be judged from such unfortunate episodes.

Based on my expertise and knowledge in medicine and healthcare, I have made an earnest attempt to dissect many of these myths in a 2-part video series (links below). The realities busting these fallacies that you see in the videos have been factchecked and corroborated through reliable and bona fide resources like WHO. I firmly believe that we as individuals need to play a much bigger role in this fight against the coronavirus and we can begin by putting a stop to misinformation about the contagion being circulated online.

Links to the ‘Coronavirus-Myths vs Reality’ video series:

Part 1: https://www.youtube.com/watch?v=TJOaScJ_3ic&t=19s

Part 2: https://www.youtube.com/watch?v=F5R7ta3o-5I&t=13s

About the Author

Dr. Anuj Chawla is one of the leading Orthopedics and Foot & Ankle Surgeon in India. He can be contacted at dranujchawla@gmail.com. For consultation with Dr. Anuj, book an appointment by visiting the website: http://dranujchawla.com/.

Twitter: @dranujortho

Facebook: https://www.facebook.com/doctoranujchawla/