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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/

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Public Health

Covid19 – The 42 day theory

India has extended its lock-down by another 19 days. This effectively means that for 40 days 1.3 billion people will technically stay at home to fight an unknown enemy. This has been unprecedented and may have major impacts on the nation in various ways. In my article I will take the reader through the 42 day theory which explores when the rate of new cases starts slowing down. I will also take the reader through some encouraging and worrying signs in a few Indian states.

Before we go any further, we would also like to share the Covid19 Projection Model (CPM19 performance). On April 8th the model projected India’s cases to reach 9K by 15th April. India stood at 11.4K cases. This bump can be attributed to the huge number of cases reported on 13th April.

The 42 day Theory

While observing the data, we had theorized that it has been taking an average of 42 days (after reaching 100 cases) for a country to slow its growth rate. Definition of Slow Down – Bring the rolling 7 day average of daily growth% of new cases to less than 5%. Roughly this is when the curve has been observed to have flattened. 

To study this hypothesis we considered India, Italy, USA, Iran, Germany, Spain, France and Sweden. Sweden is a new addition as we wanted to include a country with minimal restriction in terms of lockdown.  We removed South Korea as it seems more of an outlier. 

We defined the day the country reached the 100th case as “T”. Thereafter we looked at growth rates on a day to day basis. One week after T would be T+7. We then sought to identify the day the  moving average dropped below 5%.

What we observed

Italy

Italy took 41 days after reaching 100 cases to bring its 7 day rolling average to below 5%. Italy has reported on an average 3.8K cases per day since then in these 12 days. This number for the previous 12 days before the 42nd day was at 5.1K per day. 

To get the numbers in perspective, 24 days ago, Italy reported 5560 new cases. Yesterday, Italy reported only 2667 cases. 

Iran

Iran took 43 days after reaching 100 cases to bring its 7 day rolling average to below 5%. Iran has reported on an average 1.7K cases per day since then in these 8 days. 

This number for the previous 8 days before the 43rd day was at 2.6K per day. To get the numbers in perspective, 16 days ago, Iran reported 3110 new cases. Yesterday, Iran reported only 1512 cases. 

Spain

Spain took 39 days after reaching 100 cases to bring its 7 day rolling average to below 5%. Spain has reported on an average 4.6K cases per day since then in these 7 days. This number for the previous 7 days before the 39th day was at 6.3K per day. Spain has seen an anomalous day yesterday as the number of new cases shot up to 6.5k after going steadily down. How this pans out is yet to be seen

Germany

Germany took 40 days after reaching 100 cases to bring its 7 day rolling average to below 5%. An average 3K cases per day have been reported since then. This number for the previous 7 days before the 40th day was at 5K per day. To get the numbers in perspective, 14 days ago, Germany reported 6813 new cases. Yesterday, Germany reported only 2543 cases. 

France

France has just gone below the 5% threshold, two days ago so we need to study it to make sure there is no erratic behavior.

USA 

The USA is currently on its 45th day. Right now it’s showing a 7 day rolling average of 5.8%. We believe it will go below the 5% mark by the 48th day

Sweden

Sweden is currently on its 41st day and its 7 day rolling average  yesterday was 5.1%. We believe it will go below the 5% mark today i.e. on the 42nd day.

Based on this we postulate that an average it takes 42 days for a country to really slow down the growth of new cases reported.

To see where India fits in these trends, we tracked the maximum and minimum 7 day rolling average of the daily growth rate each day for all the countries.

For example if on a particular day Italy’s 7 day rolling average of the daily growth rate was 25% and it was the highest for that day it was considered as MAX value. Similarly we arrived at a MIN value. 

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Hence we had a MAX and MIN value for the day along with the average growth rate for all 8 countries. This gave us the outer limits and we tried to see how India’s curve fit within these limits. (See Graph)

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As you can clearly see that India is pretty much following the average path, we can easily postulate that India may fall below the 5% threshold by the 44th day after reaching its 100th cases. We are currently on the 32nd day. This means that by 28th April 2020, we should definitely start seeing a very visible slowdown. This is also corroborated by the CPM19 model that we have worked upon.

Encouraging Signs from Indian States

When we look at the trend in the last seven days for the Rolling Average of daily growth rates, there clearly emerges encouraging trends from a few states. (See Graph)

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Kerala has clearly flattened its growth rate below 5% and it seems to be on the path to recovery. The remaining 4 states AP, Kar, Tel and TN are showing signs of slowing down. Haryana is another state that has shown vast improvement in the last few days. These states will pull down India’s growth rate. What has definitely worked in these states is the high level of contact tracing. Ker, TN, Kar and Har have started doing door to door tracing in the containment and hot zones.

The worry zones

Maharashtra and Delhi remain a concern, but as we had mentioned in our previous article there were a few states like MP, Gujarat and Rajasthan that were showing early signs of growth. These states now have full blown growth of new cases and their 7 day rolling average is now higher than Maharashtra and Delhi. 

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Although it may be premature but Maharashtra and Delhi may be showing some signs of slowing down. But MP, Raj and Gujarat may spoil the gains from the slow down of the above two states. 

What’s Next For India

With the extension of the lockdown, India has bought some time. If we follow the trend we should be looking at slowing down the rate of growth after around 25K+ cases. Even if we slow it to a daily growth of 1% we will still be adding 250 new cases daily. This will only be possible in an extended lockdown. Eventually, due to economic factors lockdown will be lifted and we may see a second wave.

The situation for India seems bleak because then the second wave would mean that our medical system will be stretched tremendously.  At whatever level possible restricted movement and social distancing will continue to be the main tool to manage the pandemic in India. Or else, we should seriously hope that the hot Indian weather has an effect on the virus and that it disappears completely.

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.

(Also published on LinkedIn- https://www.linkedin.com/pulse/covid19-42-day-theory-sanjeev-prakash/?trackingId=dR%2FJUX2nQ0CyD7v0iG69Ew%3D%3D)

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Public Health

Covid19, Pandemics, Public Health & Anthropology

A cultural interventionist perspective by Bhaskara Venkatesh

Social scientists, anthropologists, in particular, have for some time been recognized as potentially important players in emergency public health efforts, particularly in outbreak response. In 1996, Paul Farmer called for a ‘critical anthropology of emerging infections’—a new field that could identify the social, economic and political factors underpinning health emergencies and thus positively shape the course of health interventions. In the years that followed, Farmer’s call was met by a contingent of researchers eager to use anthropological skills to support outbreak response.

Public health hazards like epidemics or even pandemics have scale and it cut across various cultural, social geographies across the globe, like the ongoing pandemic of COVID 19.

Epidemics do have a pattern, which eminates at one cultural/ social setting and spreads across. In the past 5 decades the world has witnessed and suffered from, Ebola (since 1976 on and off) Sars (2003) H1NI/Swine flu (2009), Zika (2015) and now COVID19 (2019).

Human history has a list of pandemics, with varying fatalities mostly viral in nature with some bacterial pandemics such as Plague being an exception.

Viral pandemics are predominantly “zoonotic” in nature which is inter-species, as human interactions with animals led to transmissions of the virus from animals to humans leading to large breakouts of the epidemic, like H1N1 from birds, COVID19, (pangolins/ bats), Sars (pigs), Ebola (bats).

Why Anthropology?

‘Anthropology is the study of what makes us human.’ Anthropology studies differences in humans (and other primates) through space and time. All humans share the same fundamentals of genetics, physiology, and neurology. Similarly, they share the same basic needs for food, shelter, security, reproduction and social expression. However, the environments, mechanisms, and interactions that humans use to meet their needs vary widely and manifest in surprisingly diverse social, ecological and epigenetic differences among and between individuals and populations. Anthropology starts from these shared fundamentals to examine diversity and variation.

Anthropology encompasses many different subfields, from primatology to museum anthropology. What they have in common is the emphasis on understanding human social and biological variation through a holistic, that is to say multifactorial, perspective: accounting for the influences of history and people’s natural, social and built environments, because of this holistic approach, anthropologists’ subject matter (if not their methods) may overlap with history, economics, sociology, psychology and, increasingly, the health professions.

Given the central importance of social practices in public health emergency (eg, health and hygiene behaviors), emergency responders will most frequently encounter sociocultural anthropologists, who study human social variation: differences in human behaviors, customs, values and outlooks?

There exists an academic debate public health continues to be dominated by a biomedical approach to health. In public health, infectious disease management is a high-priority area due to a large number of existing and emerging infectious diseases, such as malaria, measles, diarrheal diseases, tuberculosis, Ebola, Zika, Nipah, etc. All of these poses numerous and complex challenges in detecting and managing them. Anthropological interventions in disease management during outbreaks have proven significantly effective especially to manage epidemics of the social scale.

In recent decades, Anthropology along with other social sciences like psychology, sociology, social statistics, have effectively intervened in controlling infectious diseases like HIV / AIDS and the management of Tuberculosis through DOTS.

In the current COVID-19 crisis, epidemiologists and other health experts are working tirelessly to understand the scale of the problem and to help develop strategies to mitigate risks associated with it.

Anthropological social interventions such as social distancing, rigorous social communication of personal hygiene, generating awareness across various segments to prevent the spread is considered and proven effective in mitigating the spread of COVID-19 and reducing the risk of the scale and pressure on health institutions during the outbreak and further on.

It is imperative to focus on inter disciplinary collaboration and approaches involving epidemiologists, social, behavioral scientists and other disciplines in designing innovative, culturally sensitive and precise public health interventions to respond to crises and also enable us to be better prepared for such public health emergencies in future.

About the author

Bhaskara Venkatesh is a master’s in Anthropology and works as a senior manager with the technology industry.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873540/

https://science.thewire.in/health/how-the-social-and-behavioural-sciences-can- help-us-beat-the-pandemic/

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Public Health

Is the lockdown working for India in its fight against #Covid19

Well yesterday on a rare occasion when I met one of my neighbors, we had a small discussion on the lockdown. My neighbor was of the opinion that the lockdown was hurting India more than Covid19 itself. He went on to say that daily wage laborer which is most of the rural and unorganized sectors were given no warning and now will drop into extreme poverty.

His arguments jarred me at that instant. As a doctor, I had taken an oath to save lives and this is not an ideal discussion, saving lives is a priority and economics of survival is slightly outside the scope of the Hippocratic Oath.

As we near the 21 days of lockdown, the government of India has released the statistics of the lock down. According to the reports the numbers, we seem to be doing well because of the lockdown.

“If India had not implemented either containment or nationwide #lockdown – case growth by 41%, 8.2 lakh #COVID2019 cases by Apr 15″

– statistical analysis by the Ministry of Health and Family Welfare, Government of India

The government figures give 3 scenarios

  1. No containment or lockdown- 820,000 cases of Covid19
  2. Containment but no lockdown- 120,000 Cases of Covid19
  3. The current number of cases -7,447
(Ministry of Health and Family Welfare Government of India)

Clearly it is evident that according to the government the Lockdown and Containment have worked. But a lot has to be seen how we ride out of this storm.

I always believe that India like Abhimanyu from Maharashtra, Knows how to get into the Chakravyuh, now the question is unlike Abhimanyu who failed to find his way out and meet his doom, would India navigate successfully out of this Covid19 Chakravyuh?

Only time shall tell…..

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Public Health

COVID19 Vaccine: Where do we stand

(The following is a guest post by Dr Sumeet Kad)

As countries are implementing extreme measures to arrest the growing concerns due to COVID-19, all eyes are collectively hoping for an elixir – a viable vaccine. Various research organizations, government institutions, academia and pharma giants across the globe are working and collaborating at an unprecedented pace to formulate a vaccine. According to the World Health Organization (WHO), there are already two clinical trials underway and more than 60 vaccine candidates in pre-clinical evaluation.  On average, 10.7 years are taken from the pre-clinical stage for the vaccine to be developed. A vaccine for the EBOLA virus was released after 5 years. However, analysts are being Panglossian and expect a vaccine to be available in early-mid 2021. To augment the fight against coronavirus, innovative regulatory mechanisms, enhanced manufacturing processes, and new technologies platforms have come to the forefront. Many countries are adopting several initiatives in their quest for a cure or vaccine.

mRNA Vaccine

Pfizer is partnering with BioNtech for utilizing mRNA (messenger RNA) technology to develop the vaccine. This vaccine is expected to go for human trials in April. The mRNA technology platform is widely used for finding a cure of infectious diseases due to the low cost involved in production and its better safety profile. Sanofi has also undertaken mRNA vaccine research and hope to begin the clinical testing by end of this year.

Indian organizations such as Pune-based Serum Institute of India, largest vaccine manufacturer in the world, is collaborating with two American companies to develop a covid19 vaccine. Over 20 research institutes in India are working overnight to develop coronavirus vaccine.

Blood Plasma Therapy

The underlying principle behind the blood plasma therapy is that the blood of a cured COVID-19 patient would have developed certain antibodies that can help a severely ill patient combat the virus and help in recovery. The same therapy has been successfully implemented for treatment of other infectious diseases in past such as SARS, MERS and HINI. ICMR (India Council of Medical Research) considers this as a viable option of treatment in the absence of a vaccine and could try it out in few states in India. Maharashtra, Delhi, Tamil Nadu and Kerala are waiting for Government’s nod to conduct convalescent plasma therapy trials on patients.

There have been few studies in China and US highlighting that few COVID patients have recovered using this therapy.

Anti-malarial and Anti-viral Drugs

Although there is no robust study which substantiates the effectiveness of the anti-malarial drug- Hydroxychloroquine (HCQ) to fight of coronavirus, many countries are vouching its use. India is the biggest producer of this drug and has agreed to export it to US, Israel and other countries in need. The potential usage of this drug against COVID-19 is under investigation in numerous trials. If proven effective, then this could a potential savior as the drug is cheap and can me made easily available where required. ICMR in India has recommended HCQ for asymptomatic healthcare workers involved in the care of suspected or confirmed cases of Covid-19.

Clinical trials are also in motion to check the efficacy and safety of an influenza anti-viral drug -favipiravir for Coronavirus patients. It is widely produced by Japanese drug-maker Fujifilm.

Protein & Vitamin Supplements

Sesderma, a Spanish firm has claimed to successfully treat 75 COVID19 patients in Spain with its immune-strengthening supplemental drug. The company plans to work with ICMR in India for further clinical trials and is successful, this drug could be potential solution to end the pandemic.

Clearly, swift work is being carried out to speed up the process to discover a potential solution that could end this crisis. The challenges for developing a vaccine are multifold but human resolve has been able to overcome massive hurdles in the past. It’s a matter of time and till then the entire human race is hoping for the miraculous Covid19 killer.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care.