Challenges of Covid Vaccination-2021


If 2020 was consumed by Covid Virus ,  the next year 2021 will be  for Covid vaccination.

All over the world, billions of people are going to get vaccine.

Corona vaccination is one of the most anticipated events in every country. in coming weeks, multiple vaccines   are likely to get regulatory approval. 

    However, while making a good vaccine was the difficult part, earning  trust of public in vaccine is going to be another one. Especially the hurried development at Pandemic speed  and lack of awareness about safety issues will be areas of concern.

  The adverse events, which are unexpected medial problems that occur with drug treatments, are unavoidable part of any treatment, including vaccine science.

    The system need to be in place to identify  the causal relationship between vaccine agent and  the adverse event.  The objective criteria have to be in place to identify and treat, as the population to be vaccinated is also very large.

 The main hurdles equally challenging will be sourcing, distributing and giving the actual vaccination doses.

The preparation for mammoth exercise will also be a herculean task. It may take months to get ready to supply and build the chains and preparation for this need to begin now.

A systematic approach needs to be ready, so that the process of vaccination gets on smoothly and quickly, as soon as the doses are available. For example, the need for transport vehicles and the storage facilities for billions of doses at distant places will be one of challenges.

It will take mammoth number of healthcare workers, who will vaccinate people at different towns and cities.  

This exercise, if not done in a well-planned manner, could result in chaos.   The failure to set up a system will not only result in suboptimal vaccination but also non uniform supplies. Maintaining the cold chain will be crucial for effectiveness.

 People should get it based on needs rather than black marketing or money power.   The issues which look insignificant like the financial complexity among various stake holders or customer clearances need to be settled first, as they may become significant hurdles for smooth distribution.

    Most important would be to safeguard citizen’s faith in vaccine and clinical trials. As for the future science to develop, would   require people’s co-operation, faith and participation.

     Government regulators and Vaccine makers need to recognize the utmost importance of the communication about the true results of trials and effective communication with the public.  The misinformation and distrust should not  undermine the good work of medical science and advancements.

     Advantages-Disadvantage of being a doctor

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     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Neanderthal gene makes Covid more severe


What is Neanderthal gene

    Neanderthal-inherited genetic material is found in all non-African populations and was initially reported to comprise 1 to 4 percent of the genome. This fraction was later refined to 1.5 to 2.1 percent. It is estimated that 20 percent of Neanderthal DNA currently survives in modern humans.

Relation to severity of Covid

    Response to Covid infection varies from person to person. Some have severe covid infection, need ventilator and some remain unaffected. There is interest in the individual factors which influence the outcome of Covid infection. One such factor is the genetic predisposition.

     Covid-19 patients with a snippet of Neanderthal DNA that crossed into the human genome some 60,000 years ago run a higher risk of severe complications from the disease, researchers have reported.

People infected with the new coronavirus, for example, who carry the genetic coding bequeathed by our early human cousins are three times more likely to need mechanical ventilation, according to a study published Wednesday in Nature.

There are many reasons why some people with Covid-19 wind up in intensive care and others have only light symptoms, or none at all.

Advanced age, being a man, and pre-existing medical problems can all increase the odds of a serious outcome.

But genetic factors can also play a role, as the new findings makes clear.

“It is striking that the genetic heritage from Neanderthals has such tragic consequences during the current pandemic,” said co-author Svante Paabo, director of the department of genetics at the Max Planck Institute for Evolutionary Anthropology.

Recent research by the Covid-19 Host Genetics Initiative revealed that a genetic variant in a particular region of chromosome 3 — one of 23 chromosomes in the human genome — is associated with more severe forms of the disease.

That same region was known to harbour genetic code of Neanderthal origins, so Paabo and co-author Hugo Zeberg, also from Max Planck, decided to look for a link with Covid-19.

Unevenly distributed

They found that a Neanderthal individual from southern Europe carried an almost identical genetic segment, which spans some 50,000 so-called base pairs, the primary building blocks of DNA.

Tellingly, two Neanderthals found in southern Siberia, along with a specimen from another early human species that also wandered Eurasia, the Denisovans, did not carry the telltale snippet.

Modern humans and Neanderthals could have inherited the gene fragment from a common ancestor some half-million years ago, but it is far more likely to have entered the homo sapiens gene pool through more recent interbreeding, the researchers concluded.

The potentially dangerous string of Neanderthal DNA is not evenly distributed today across the globe, the study showed.

Some 16 percent of Europeans carry it, and about half the population across South Asia, with the highest proportion — 63 percent — found in Bangladesh.

This could help explain why individuals of Bangladeshi descent living in Britain are twice as likely to die from Covid-19 as the general population, the authors speculate.

Indian express-Article

In East Asia and Africa the gene variant is virtually absent.

About two percent of DNA in non-Africans across the globe originate with Neanderthals, earlier studies have shown.

Denisovan remnants are also widespread but more sporadic, comprising less than one percent of the DNA among Asians and Native Americans, and about five percent of aboriginal Australians and the people of Papua New Guinea.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Covid Patients Remain Infectious for 9 days


Covid-19 patients can shed fragments of the virus that causes the infection for up to 83 days in their respiratory or stool samples but they are unlikely to be infectious for as long. According to a study published in The Lancet Microbe, one of world’s top medical journals, no live virus has been isolated from culture of the respiratory or stool sample beyond day nine of symptoms despite persistently high viral RNA loads. This means that a person affected by Covid-19 is infectious for nine days after developing disease symptoms though tests may find presence of the virus for nearly three months. The study conducted by researchers from UK and Italy involved systemic review and meta-analysis of 79 studies that focused on SARS-CoV-2, the virus which causes Covid-19. “The majority of studies included in our review were performed in patients who were admitted to hospital. Therefore, our findings may not apply to people with milder infection although these results suggest those with milder cases may clear the virus faster from their body. Additionally, the increasing deployment of treatments, such as dexamethasone, remdesivir as well as other antivirals and immunomodulators in clinical trials are likely to influence viral shedding in hospitalised patients. Further studies on viral shedding in this context are needed,” Dr Antonia Ho of MRC-University of Glasgow Centre for Virus Research, UK, who is one of the authors of the study, said.

article- times of india

                The Lancet Microbe study also suggests that people infected with SARS-CoV-2 are mostly likely to be highly infectious from symptom onset and the following five days. Therefore, the researchers said, it is important to self-isolate immediately after symptoms start. Understanding when patients are most likely to be infectious is of critical importance for informing effective public health measures to control the spread of SARS-CoV-2. The Lancet study looked at key factors involved in this: viral load (how the amount of the virus in the body changes throughout infection), viral RNA shedding (the length of time someone sheds viral genetic material (RNA), which does not necessarily indicate a person is infectious, as this is not necessarily able to replicate), and isolation of the live virus (a stronger indicator of a person’s infectiousness, as the live virus is isolated and tested to see if it can successfully replicate in the laboratory). The researchers found that the average length of time of viral RNA shedding into the upper respiratory tract, lower respiratory tract, stool and serum were 17 days, 14.6 days, 17.2 days and 16.6 days, respectively. The longest length of time that RNA shedding lasted was 83, 59, 35 and 60 days, respectively. “These findings suggest that in clinical practice, repeat PCR testing may not be needed to deem that a patient is no longer infectious, as this could remain positive for much longer and does not necessarily indicate they could pass on the virus to others. In patients with non-severe symptoms, their period of infectiousness could instead be counted as 10 days from symptom onset,” Dr Muge Cevik, the lead author of the study, said.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Admin Apathy- Kerala Doctors to Protest State’s ‘lack of concern’


         Doctors and nurses are now  getting out of their own self-imposed moral enslavement. Rather they are now forced to do so, as their lives and deteriorating working environment are becoming impossible to be in. One cannot burn himself in a furnace for eternity, for the well-being of others, especially if others are not concerned.

      The incidents at few places are just a tip of the iceberg. Covid has helped doctors to bring forth their plight. Doctors and nurses not paid for months in some Delhi Hospitals.  Doctors openly ridiculed and scolded by Administrators for no fault of theirs. Even a doctor lynched by mob in Assam and many assaulted at other places. Hospitals vandalized indicate that there is danger lurking for doctors everywhere. Most sad part is that, there are no firm administrative hands to deal with the menace.

     Clearly Well being of doctors and nurses is not being taken care of. They are being used as dispensable disposables. Such system, which is based on exploitation of the health workers, is becoming fast unsustainable. If apathy towards their genuine problems continues, negative attitude towards doctor and nurses persists,  it will kill the empathy towards patients as well.

 Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

Government doctors in Kerala to boycott additional duties

    The Kerala Government Medical Officers’ Association (KGMOA) has declared that government doctors will stay away from all additional duties from Thursday, in protest against the government’s apparent lack of concern about the plight of health-care workers who are overworked and fatigued, fighting on the front lines for the past nine months.

  The KGMOA has, however, made it clear that while declaring non-cooperation, COVID-19 care and disease containment activities will not be disrupted.

In a statement issued here, the KGMOA said that apart from ignoring the KGMOA’s repeated demand for deploying additional human resources in COVID-19 care activities, the government’s decision to take away the leave given to health-care workers after continuous COVID-19 duty was something that defied all principles of fairness. This was totally unacceptable, the KGMOA said here.

   Advantages-Disadvantage of being a doctor

   25 factors- why health care is expensive

   REEL Heroes Vs Real Heroes

   21 occupational risks to doctors and nurses

   Covid paradox: salary cut for doctors other paid at home

Are Doctor & Nurses Dispensable Disposables?


 

It is surprising that  doctors and nurses, who can save many lives, have to put their own lives at risk for the want of proper PPE’s. The cost of PPE’s is not more than few hundred rupees.  Even such a cheap facility is not available to the saviors for their own protection. Such episodes are not only  painful to the medical fraternity but also expose the hypocritical  attitude of the administrators as well as  the insensitive approach of society towards health care workers, although everyone expects doctors and nurses to be sensitive towards every one. Such incidents demoralizes and causes deep discouragement to the front line doctor and nurses, but sadly remains a routine business for administrators. The pain of being  treated like a dispensable disposables remains as  a deep hurt within.

10 govt docs, 70 private nurses have quit in Telangana over safety, hospital infra.   (Times of India)

 

At least 10 senior resident doctors deputed on Covid-19 duty at government hospitals and 70 nurses in private facilities have quit their jobs, with most citing poor protective gear to combat the virus as a reason.

While the senior residents said they were dejected with the poor state-of affairs at hospitals and the looming threat of contracting the infection, some individual doctors and nurses took a break from the profession, until the pandemic, gets over. These doctors are from the Osmania Medical College (OMC) and Mahatma Gandhi Memorial (MGM) hospital Warangal among other government hospitals. So far, 300 doctors and other medical personnel in the government sector alone have contracted the virus, with worries of sub-standard protective gear and long working hours, forcing doctors to even go on strike. Some senior resident doctors deputed from the OMC to the Chest Hospital never reported for duty, while others served for one or two months before putting in their papers. “The problem is not just that there was a threat of infection and we didn’t get proper personal protection equipment (PPE) kits, it seemed like a waste of effort. Even if a patient was dying in front of me, I could do nothing at all,” said one of the senior resident doctor who had resigned from the OMC .

“We didn’t have staff, we didn’t have the infrastructure, we didn’t have proper PPE kits or any other provision required. It seemed like a futile effort,” he said. Despite the guilt of having resigned in the middle of an ongoing pandemic, the doctors said that their presence or absence hardly made any difference to the situation. Authorities ignored repeated complaints It was like there is everything wrong, but no one was there to take responsibility. I felt bad about resigning but after over a month of working and making repeated requests for additional doctors and nurses, there was no difference. It was just a blame game,” another doctor told TOI. From the medicine department at Osmania General Hospital (OGH), six senior residents have resigned, while few others have resigned at the MGM hospital, said Dr Mahesh Kumar, president, Healthcare Reforms Doctors Association (HRDA). “At the beginning of the pandemic, there was a lot of issues with PPE kits and infrastructure and despite repeated representations they were not sorted out. Most of the residents resigned in the first two months of the pandemic, discouraged by the situation and fearing for their personal safety,” he added. Apart from doctors, 70 nurses who are at the frontline have gone missing from work too. “A least 30 of these nurses went missing from a single corporate hospital. Currently, there is a huge shortage of nurses as most are reluctant to do Covid-19 duties,” said Laxman Rudavath, president, Nursing Officers Association of Telangana.

 

25 factors, why health care is expansive

21 occupational risk factors for doctor and nurses

Altruistic professions are not cherished

Administrators refrain risk to doctor and nurses

REEL Heroes Vs REAL Heroes

Covid war- unhappy soldiers: says Supreme court


 

In present era, these are toughest times for health care staff and hospitals as well.  Warriors on the front lines are doctors and nurses, whereas hospitals are grappling with financial constraints.  What should have been most   desirable at this crucial time, was the   encouragement and psychological support to these warriors.  Administrators were supposed to give some moral boosting and financial support or at least, the rightful, so that health staff  should work willingly and inspire next generation for future catastrophe like this.  Instead of armchair preaching to health care staff, there should have been robust  rules and guidelines to protect health care staff and health systems as doctors and nurses are working under tremendous psychological pressure.

But the desired did not happen, as the chaotic management due to economical compulsions or just trying to be projected as an outstanding administrator turned out to be a real possibility rather than exception.

Moral and legal compulsions thus caused  immense pressure on health care workers  and  they became an  easy  subject  to moral and legal blackmail.  The  pressure to perform their duties in sub-optimal and below par conditions became a new norm.  

Every day when doctors and nurses, while going to work have this thought in mind. But still they continue to work amid their own tensions, worries about families.

The non-payment of salaries, disrespect to health care staff and being made to work in below par conditions, without PPE’s at some places has caused tremendous discouragement to the medical profession.

 

In war, you don’t make soldiers unhappy, says SC on non-payment of salaries to doctors

The courts should not be involved in the issue of non-payment of salary to health care workers and government should settle the issue, it said.

NEW DELHI: “In war, you do not make soldiers unhappy. Travel extra mile and channel some extra money to address their grievances,” the Supreme Court said on Friday taking serious note of non-payment of salary and lack of proper accommodation to doctors engaged in fight against Covid-19.

The courts should not be involved in the issue of non-payment of salary to health care workers and government should settle the issue, it said.

The top court was hearing a plea by a doctor, who alleged that front line healthcare workers engaged in fight against Covid-19 are not being paid salaries or their salaries are being cut or delayed.

The doctor also questioned the Centre’s new SOP making their 14-day quarantine non-mandatory.

“In war, you do not make soldiers unhappy. Travel extra mile and channel some extra money to address grievances. Country cannot afford to have dissatisfied soldiers in this war which is being fought against Corona,” said a bench of Justices Ashok Bhushan, S K Kaul and MR Shah.

Solicitor General Tushar Mehta, appearing for the Centre, said that if there are better suggestions coming forward, they can be accommodated.

The bench said that there are reports coming that many areas doctors are not being paid.

“We saw report that doctors went on strike. In Delhi, some doctors have not been paid for past three months. These are concerns that should have been taken care off. It should not require court intervention.”

The bench further said, “You (Centre) need to do more. Must make sure their concerns are addressed”.

The bench posted the matter for further hearing next week.

On June 4, the Centre had told the top court that a “large number” of make-shift hospitals will have to be built in the near future to accommodate the constant rise in the number of newly infected people.

The Centre also contended that though hospitals are responsible for implementing the Infection Prevention and Control (IPC) activities, the final responsibility lies with the health care workers to protect themselves from COVID-19.

It further said mandatory quarantine for 14 days after the duty of healthcare workers of 7/14 days is “not justified and warranted”.

“It is most respectfully submitted that number of cases of COVID-19 are constantly increasing and at some point of time in near future, apart from existing hospitals, large number of temporary make-shift hospitals will have to be created in order to accommodate COVID-19 patients requiring admission, medical care and treatment,” the Ministry of Health and Family Welfare said in an affidavit.

The affidavit was filed on a plea by Arushi Jain who questioned the Centre’s new Standard Operating Procedure (SOP) of May 15 for front line COVID-19 healthcare workers by which it ended the 14-day mandatory quarantine for them.

The ministry in its reply affidavit had said healthcare workers (HCW) are properly protected by Personal Protective Equipments (PPE) in workplace settings and carry no additional risk to their families or children.

It had said grievances raised by the petitioner alleging infirmities in the May 15 guidelines of the health ministry are completely presumptuous, vacuous, ill-founded and sans any empirical or medical evidence.

Justifying its advisory and SOPs, the health ministry said it is a step in the right direction and that the guidelines emphasise the role of taking adequate preventive measures by all health care workers in the hospital setting against the likelihood of contracting infection at their work place.

On April 8, the apex court had observed that the doctors and medical staff are the “first line of defence of the country” in the battle against COVID-19 pandemic, and directed the Centre to ensure that appropriate PPEs are made available to them for treating coronavirus patients.

Altruistic professions not cherished in present era

Enslavement of doctor and nurses

 

21 occupational risk to doctor and nurses

 

Immunity business in corona times


About the medicines and substances, that  are consumed by masses under a false hope of immunity enhancement. Every substance, which claims to alter human physiological functions should undergo strict international neutral trials and not allowed to be sold by mere advertisements.

Tremendous misguidance is propagated by giving a false hope to people of doing some treatment.

Every day we read in media the various pronouncements claiming to enhance the immunity especially in the  days of Covid-19. It automatically implied  or interpreted that the said product will save  the people from Corona and hence a brisk business starts. No one has studied the real effectiveness, correct  doses or side effects of preparation in real sense.

 

A myth, that any plant extracted drug is useful, free of side effects, is a belief ingrained deep in the minds of people. Such unscrupulous  advice is followed blindly without even verifying the authenticity of the source. A hope of miracle is flashed to patients who perceive  a “no hope” by scientific medicine, are an  easy prey for such fraudsters.

Another major problem  is that medicines and syrups distributed in such manner often  are without name of drug, contents and doses. It is not uncommon to get lethal substances like steroids, hormones and heavy metals in dangerous doses.   Such acts  are  real crime to society, done with an intention to cheat rather than treating them.

Any one selling  medicines in name of alternative medicines, food supplements or medical advice of any kind, has to be registered with a council, for those particular medicines. advertisement of such drugs or products should be on some scientific basis and neutral trials.

 

Most of these are not validated at all by international or national authorities, not even considered as drugs. No impartial, neutral trials conducted about effects, side effects or toxicity. Mere media or social media words, which are paid, are considered as  Gospel  Truth  and substances are consumed by masses under a false hope of immunity enhancement. Most of them marketed as herbal or alternate medicines, which are advertised as harmless but beneficial. They are sold by propagated words of benefit  and advertisements rather than a solid proof.

Slowly these medicines become part of conventional wisdom rather than  considered as drugs and chemicals or heavy metals.  In reality, being a settled medical science issue, it remains a fake news at the basis.

There is no dearth of quacks, who sell unknown and unlabelled substances, merely  to earn money, but the dangers of such products are high and unassuming consumers remain oblivious to side effects.

   Any substance is considered effective only after rigorous testing through randomised clinical trials  and additional laboratory analyses.  The substances that are merely propagated on social media or claims of company or advised by quacks will not help and merely remain as part of immunity business. They provide a false hope and thereby earn money  because of fear in the minds of masses.

Times of India carries a report about the brisk business being done, while people are looking at ways to enhance their immunity.

Any substance which claims to alter the physiology of a person or patient, cannot be consumed  without undergoing rigorous, neutral and international  safety trials. If found to be good, all  homo sapiens in the world should be benefitted. If not,   let the gullible masses not be misguided and trapped into a false hope. There has to be a strict Government  control about the products to be consumed, which claim to alter human physiology.

Balancing immunity in Corona times

 

Who will treat people in next Pandemic?


Pandemic has unmasked the real risk to doctor and nurses. The occupational risk of being among the diseases, that was known to them, has been unveiled to everyone. That should have generated respect for health workers in a civilized society. What was actually desirable, was the encouragement and psychological support to these warriors. Good administrators were supposed to give some moral boosting and financial support, so that health staff should work willingly and inspire next generation for future catastrophe like this. Instead of armchair preaching to health care staff, there should have been robust rules and guidelines to protect health care staff and health systems as doctors and nurses are working under tremendous psychological pressure.

More importantly, among this chaotic situation, whether rules are being followed or not, how administrators are doing can be at the most a guess work, rather than following a uniform system. The possibility of chaotic management due to economical compulsions or just trying to be projected as an outstanding administrator may be a real possibility rather than exception.

Health care workers can be easily subjected to moral and legal blackmail or pressure to perform their duties in sub-optimal and below par conditions. They can be subject to moral, legal, financial or even pressure of physical assaults. Such pressures can be tremendous in health sector because of financial complexities.

Is the payment made to them is commensurate to the risk to their life and work they do? Who will pay them and how much in case harm or death of health care worker, every one refrains to discuss?

Are they given the real respect, what they deserve and are worthy of?

Every day when doctors and nurses, while going to work have this thought in mind. But still they continue to work amid their own tensions, worries about families. While it is clear to them that administrators refrain to discuss the issues, which matter to them the most.

Times of India carries a report that the interns will be punished, if they become positivefor Covid, while doing duties. Although possibly the circular is withdrawn, but it reflects the deep seated and hidden mental frame of administrators, about the intention, how they wish to behave with doctors. Why such punishments are not for other Government functionaries or officials or even public, who test positive. It is just an example, but there are numerous examples of such kind.

MUMBAI: The department of community medicine at KEM Hospital issued a circular on Thursday asking interns to give a written explanation on how they had been exposed to the Covid-19 infection, after an increasing number of interns went into quarantine. It further said they will be liable to repeat their internship for the duration period of the quarantine if there was any negligence in following “Covid-19 discipline”. The circular was withdrawn within a few hours, after it faced criticism from many. Doctors and students termed the circular “insensitive” and “unwarranted” during a pandemic. Dr Sagar Mundada, psychiatrist and former president of Maharashtra Association of Resident Doctors, called the circular insensitive. “It is a pandemic. Why medical interns should be asked about the source of the infection?” An intern said some of them have been working for three months without stipend while their duty hours have been increased to 12. They collect swabs, blood and insert IV. 6/6/2020 Mumbai: KEM questions interns over quarantine, then backs off – dean Hemant Deshmukh said he had not signed the circular and it will not be implemented. Dr Gajanan Velhal, who signed it, said it was misunderstood. “No such action will be taken against any interns,” he said. Rajvi Bheda, a representative of the Association of State Medical Interns at KEM, said it seemed to be an attempt to ensure interns stay safe. “But it was unfair to the interns too, as it is difficult to identify the source of infection.

As Corona has unmasked the real risk to health workers and society has dealt with heath workers shabbily. Next younger generation of aspiring doctors, who is a witness to the cruelty shown towards health staff, may be forced to think about their decisions to become health workers. Possibly the administrators need to ponder now, who will treat people in next pandemic.

Corona unmasks the risk to doctor and nurses, administrators refrain

Altruistic professions are not cherished in present era

21 occupational risk to doctor and nurses

Being doctor or nurse- a disadvantage in present era

Plight of nurse in Covid ward

Pros-Cons of Covid testing at admission in hospitals


 

Try not to find a hidden explosive can be a disaster. Testing after it has exploded, is of limited benefit.

Going by practical thought, testing for COVID-19 should be a non-issue, as  Up to 44% of the infection may be transmitted by pre-symptomatic patients or asymptomatic patients.

Advantages of   Covid testing at admission in hospitals   

  1. Source to other patients; Any patient  admitted with medical diseases or requiring surgery, if  Covid status  is not tested, the patient  will be mixed with others. Any one patient having Covid infection will act as a source for other patients and health workers.
  2. Further progress of Covid-19 will be influenced by the incidence of infection in the population. The true numbers of spread will be the  key to informed decision making therefore will influence the  trends. Any  orders or intention to restrict testing  defies logic. Inconsistent strategies will result in projecting an incomplete  picture of the transmission.
  3. Difficult to decide on history; It is impossible  to identify all COVID-19 patients based on history alone. One such patient could infect several healthcare workers and can significantly impact hospital services. Thus, the implications of missing a single COVID-19 patient can be enormous, in a hospital.
  4. Clear history not available; Sometimes patients are not always clear  about their history of contact or symptoms because of  many reasons. Doctors also sometimes may not be able to elicit the correct history.
  5. Generation of Data;Testing  at the hospital admission  increases   overall testing figures. It screens a population at risk of infection and source. Undertaking contact tracing and breaking the chain of transmission is helpful.  For same reasons, doctors routinely carry out testing for HIV, hepatitis B and hepatitis C preoperatively for all patients.  It is just another viral test.
  6. Hospitals turning into hotspots and risk to health workers; Hospitals are the only place, holding too many sick people. Chances of harbouring Covid, or catching infections are very high in hospitals. They can actually turn into hotspots, if testing is restricted in the hospitals. Liberal testing is one of the methods to contain infection in hospitals, so doctors can detect and segregate the source.

Disadvantages 0f Covid  testing at admission

There are some equally reasonable concerns about mandatory testing of COVID-19.

  1. First is the cost and the delay in patient management.

 

  1.    Stigmatisation if one tests positive and being refused treatment is a major fear for the patient.
  2. Universal safety precautions are always followed across all hospital surgeries, irrespective of the test result.

There are many reasons for and some against COVID-19 testing of all admitted patients. Doctors will strive to strike the balance between protecting patients and protecting  the healthcare system and workers. While treating any  patient without  delay, a more rational and practical set of comprehensive guideline is needed  for non-urgent or elective admissions from  our national and international organizations to enable health care systems  to practice medicine safely.

Otherwise every one may be at risk including  patients, health care  workers and doctors.

Inconsistent strategies of testing Covid will undermine decision making  (Times of India)

Moral burden of poor quality PPE’s on doctor and nurses#Covid time


Medical industry has found an opportunity to do a brisk business. The norms of PPE are not well defined, from the end user’s comfort,  that is doctor and nurses. Any material is that is converted into PPE and dumped on health workers, adding enormously on their plight.  A moral burden to do their  work in every situation, is becoming difficult to carry on, while the opportunist in medical industry make merry. A sin, which  may look nonpunishable in current era, but should not be forgiven in a civilized society.

Possibly working as a doctor and nurse is going to be most difficult  profession. Working in life and death situations, excessive  documentation, unrealistic expectations from patients and administrators alike, working  under legal compulsions, prone to punishments and complaints on simple human errors,  poorly paid  and facing verbal and physical assaults. Above all despite doing all this, respect and gratitude is scant for the life savers in present era. Adding to all above issues, another problem has been added, the poor quality of PPE, which makes life of saviours a hell.

Times of India  publishes a report on the same, that brings out the plight of doctor and nurses.

‘Some PPEs feel like we’re wearing plastic rice bags  from. Trussed up inside a plastic bag in the summer heat with sweat pouring down the body but afraid to drink water as it is impossible to take a loo break. This is how a nurse described the experience of wearing a personal protective equipment (PPE) suit.

While there is no dearth of PPE any more, doctors and nurses say the quality is such that it’s like wearing a plastic bag. Doctors say hospitals are besieged by companies offering PPE kits. “The quality of most of what is offered is horrible. The fabric of many is like chawal ka thaila (RICE BAG). There is zero breathability and so health workers find it impossible to wear it for long. That reluctance could endanger them,” said a senior doctor. The WHO guidelines on PPE strike a balance between protection against infection and allowing health workers “ease, dexterity, comfort and minimal heat-associated stress”. However, the guidelines framed by the ministries of health and textiles only focus on the need to prevent blood or fluid penetration but have nothing about breathability. So, manufacturers focus on thickness of the plastic rather than the wearer’s comfort. “In the initial rush to overcome the shortage of PPE, it is understandable that the ministry did not think of all aspects. But it is unacceptable to allow people to use this opportunity to make money by supplying abysmal quality PPE and endangering the  lives of health workers.

The government should immediately issue clear-cut guidelines on quality of fabric and stitching and weed out the fake manufacturers cashing in on the sudden demand for PPE,” said a doctor in a Covid hospital. According to a manufacturer of protective wear, cheap plastic laminated fabric costs just Rs 150-200 per kilo. “So even with the cost of stitching, a poor quality PPE suit would cost only Rs 100- 200 to make but is sold for Rs 500-800. With such huge margins, getting even one small order for 10,000 PPE suits would mean a profit of at least Rs 30 lakh. This is why there is a such a huge rush of people getting into PPE making,” he explained Eight labs identified by the textile ministry to do quality checks on PPE have so far issued over 900 Unique Certification Codes (UCC), mandatory for PPE sellers, especially to land government contracts.

The government says there are 600 companies manufacturing 4.5 lakh PPE suits per day. Many with the UCC have little or no experience in making protective wear. They include chemists, lingerie and footwear manufacturers, tent or tarpaulin makers, wholesale traders of drugs, small-time pharma companies, and even a food company. “Anyone who has a garage to store the stuff can buy some fabric and organize some tailors to copy a PPE suit,” said an industry insider. “One PPE lot supplied to us had electrical insulation tapes used to seal the seams. Obviously, they started coming off when we moved around,” said a doctor in a private hospital. Another doctor in a government Covid hospital pointed out that the government only tested the coverall, but other components like face shields or goggles that came with it were substandard. Almost all hospitals seem to have PPE horror stories to narrate. The government is at pains to reiterate that its certification is only for the coverall and that only a Synthetic Blood Penetration Test (SBPT) has been conducted.

Every UCC states that the certificate is based solely on the sample submitted by the applicant. It goes on to state: “The procurement agency is advised to conduct prior due diligence before placement of supply agreement…including periodical sample tests.

 

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