CovidRxExchange – A year into the Journey

As I take this moment to recap our one year journey with CovidRxExchange, with all humility I wish to honor and pay our gratitude to our Patrons, Mentors and SPOCs, Executive and our various teams who helped evolve CovidRxExchange as an initiative to reckon with –

Patrons –

Dr. Vikas Mahatme, Ophthalmologist, Padmashree, and Rajya Sabha Member
Dr. Sunil Deshmukh, Radiologist and Former, Minister, Govt. of Maharashtra.
Wing Commander Babu, Formerly IAF
Mr. I. S. Chahal, Commissioner, Mumbai
Dr. Zodpey, VP, PHFI, Delhi,

Mentors:

We are deeply humbled and honored to have mentors like –
Prof. Emeritus Dr. Manbar Rawat, a Prof. of great respect and repute across multiple generations.
Prof. Emeritus Dr. Vilas Jahagirdhar, Formerly, Prof Microbiology and Dean
Prof. Uday Bodhankar, Formerly, IAP President, VP COMHAD, UK
Prof. Vrinda Sahasrabhojaney, Retd. Prof. Medicine.
Dr. Naveen Thacker, Director, IAP

Intent and Objective:

CovidRxExchange, a global nonprofit initiative, started in March 2020 to disseminate expertise, insight, and experience in managing Covid for the doctors, Health Care policymakers, and policy planners, and administrators. The intent is to enable doctors across borders to leverage the expertise they have honed in Covid patients’ care.

In March 2020 (exactly a year back), our initial foray was to disseminate knowledge and expertise from the US to the experts at Mumbai. We arranged our first call between Dr. Toraskar, Chief of Critical Care at Wockhardt and HOD of Cardiology at Nair Hospital, and two experts from the US, who had by then gained significant experience managing critical cases of Covid. From that experience, we realized, it is best to institutionalize the knowledge transfer and make it global. After that, we started panel discussions on the practical care of Covid in HDU and ICU.

Over a period of time, as Covid kept raging across countries, economies, globally, nationally, and regionally, we realized the needs got more specific, and we differentiated our nonprofit services to include more services under our gamut of CovidRxExchange.

Scope and Out of Scope: We are aggregators and disseminators of expertise, insight, and experience. We occasionally conduct our own research. We are a global organization.

Our Ethical Values

CovidRxExchange adheres to strict ethical guidelines. Nondiscrimination and noncommercial form the backbone of our services. We are an inclusive organization devoid of leaning towards any political ideology or any faith-based ideology. We are committed to translating academic evidence-based medicine to enable doctors, policymakers, and administrators. We are noncommercial and agnostic of vendor bais in providing our nonprofit services.

Activities and Accomplishments:

A. Our Initial Engagement – Panel Discussions and Second Consultations

After conducting several panel discussions, we were approached for several second consultations. Our next group was the second consult, and our global group of experts offered a second consult in several cases. Dr. Ajay Chaurasia (Cardiology, HOD, Nair Hospital), Dr. Nandita Divekar (UK), Dr. Rahul Sarkar (UK), Dr. Hettiarchi (UK) and Dr. Sandip Banerjee (UK),

B. Web-based Knowledge Repository (Lifecycle and Extended Lifecycle Approach)

Eventually, we created a web-based repository, a library with a Lifecycle approach to deal with Covid. Our lifecycle approach provides end-to-end case expertise of different aspects of covid from remote consult, first visit, admission (floor) to HDU, ICU, discharge, and bereavement.

As Long Haul disease became prevalent, we extended our Lifecycle Model to Extended Lifecycle Model, including Stress Management for Doctors and HCW and rehabilitation.

C. Risk Management: Extending Individual Care to Institutions, Cities, and Corporations.

Realizing that Covid was no more a patient condition, we created a 3×3 model. The 3×3 model extended the services to institutions, cities, and corporations. Thus the policy planners too came under the aegis of Covid Care. We helped the City of Coimbatore, An City (Anonymous) with significant Covid to identify and restructure their Covid, and did a post facto analysis for a metropolitan area for What best could have been done. Indore team (comprising of Dr. Nishant Khare, Dr. Sanjay Dhanuka, Dr. Anand Sanghi, and Dr. Gaurav Gupta), the UK Team (comprising of Dr. Divekar, Dr. Banerjee, Dr. Sarkar), the US Team (comprising of Dr. Lakshimi Sambathkumar, Dr. Arvind Virmani and I), and the Mumbai Team (comprising of Dr. Chaurasia, Dr. Ashok Anand, Dr. Hemant Bhandari, and Dr. Pankaj Maheshwari), worked along with the Coimbatore Commissioner, Deans, and Professors to provide a blueprint for Covid mitigation in the Corporation of Coimbatore. Dr. Rajamani and Ms. Kruthka Govindarajalu, Director, Smart City, Coimbatore, played a pivotal role.

D. Tribals and Areas of Deprived Resources: Eventually, as Covid made inroads into the tribal areas/interiors and understanding that 10% of India’s population lives in Tribal Areas, we developed our Tribal Covid Model. Dr. Ashish Satav, Dr. Sahasrabhojaney, Amod, and I, spearheaded this Tribal Covid Model. Realizing that the economically deprived areas and tribals areas have shared problems, we consolidated this capability under Tribal and Areas of Deprived Resources.

E. Holistic Health: Mindfulness, Sleep, Exercise, Nutrition, and Yoga, are crucial to achieving normal health. Ms. Gomathy Periatheruvadi, an Entrepreneur and Executive from the US, is leading this capability.

F. Rehabilitation and Long Haul: This is one area where we are still striving to expand our footprint. We are exploring to develop this capability, and Dr. Mariya Jiandani has shown interest and bandwidth to expand these services.

G. Vaccines – Developing a requisite immunity is based on critical success with Vaccine deployment. Vaccines emerged as a significant area that our doctors needed an incredible amount of support. Realizing this, we organized a series of panel discussions and one on one calls to address patient concerns.

H. Variants – Mutations and their aggregation into variants created a different challenge, both in transmission, infectivity, and the second/third/fourth surge across nations. We have set up a dedicated capability and integrated this under the vaccine capability. We are exploring the implications of the variants such as B1.1.7, B1.351, P.1, B1.521, and the recent variants found in India and other countries on the transmission, infectivity, morbidity, and mortality. Dr. Mukul Acharya (UK), Dr. Anand Kawade (India), Dr. Nitin Wairagkar (US), Dr. Kedar Toraskar (Mumbai), Dr. Naveen Thacker (India), Dr. Suhasini Balasubramiam (Chennai), Dr. Anita Mathew (Mumbai), Dr. Mala Kaneria (Mumbai), and Dr. Neetu Jain (Delhi) are working under the mentorship of Prof. Dr. Rawat and Prof. Jahagirdhar.

I. Dispelling Rumors: As rumors are flying rife; we are identifying SPOC’s to evaluate, analyze, and provide a scientific evidence-based rationale to dispel rumors

J. Socialization of scientific understanding into commonly understood language is important as we consider that if our nonmedical community is aware, they can be the necessary pivot to transgressing towards success. Thus dispelling ‘Rumors and Socialization’ are emerging as recent capabilities.

K. Liaison: Covid needs an adequate translation to policy and execution. We are currently working on establishing a capability to connect with the policymakers at different Govt. Machinery levels.

L. Awareness: Specifically for the nonmedical folks based in the US, we have created an Awareness Group to share information on awareness.

M. Strategy, Risk and Program: With my background in Strategy, Governance, and Risk Management made me realize that these should include these as independent capabilities. Thus, Strategy (Wing Commander Babu and I), Governance (Founders) and Risk (Amod and I) are maturing this capability. We reinvented the industry approach on Risk Management and tweaked it to align with Covid and Medical care. Concurrently, as capabilities were sprawling, we realized a common framework should encapsulate the entire initiative. Thus, we initiated program management (with a CMMI/ISO) capability to standardize for all the capabilities. Manish Singhal has taken the onus to develop this nascent capability.

N. Legal, Compliance, Finance: While some of these capabilities are a doctor (customer) facing, many capabilities are operational and happening on the backend: operations, Legal, Compliance, and Finance capabilities. Mr. Yogesh Vyas, Mr. Amod Manjrekar, and

O. Technology: Manish Singhal, Amod Manjrekar, Pankaj Bhakta, and Shriram Devata provide that support. This is still an incipient and nascent capability where we are expecting significant development.

P. CME: These capabilities are in embryonic stages. We are exploring global sponsors and accreditation for this capability.

Q. Editorial: We are upgrading our capability to provide updates (weekly, daily, and flash). Currently, we are scaling capability to include over 2000 of our users.

R. Emerging Technology: We are building an industry consortium to address medical problems leveraging technological advances. An example can be using Artificial Intelligence and Machine Learning to address predicting the utilization of beds, or developing a model to understand the emergence of a specific variant in a specific geography and the impact of these newer (hypothetical) variants on transmission, infectivity, and overall community-based impact.

S. Ombudsman:

We strongly encourage professional interaction and courtesies. We heavily lean on Evidence-based rationale, and we respect creativity. Our ethical values are foremost essential for us, and we cherish those with the highest order. We have identified Prof. Emeritus Dr. Manbar Rawat to resolve any residual issues if not resolved by the Founder.

All along, we have ensured that only hands-on experts are providing the knowledge transfer. We are not book-based academicians. Our experts have significant hands-on experience and expertise from their specialized domain. These experts’ work contributions are pro-bono, i.e., they do not charge us, and we do not reimburse them.

Funding: As of this writing, we the Founders, have funded all the initiatives. We have not received any funding from donations, advertisements, any pharmaceuticals, or any other industry. We have avoided all and any conflict of interest.

Scaling and Continuity: We will explore submission to foundations for support. If we secure funds for CovidRxExchange, we will announce that and develop Policies, Governance, Visibility, Transparency, and Audit/Accountability.

Slack: Slack is our global portal of Collaboration and Communication. However, WhatsUp is a transitory and stop-gap arrangement to support ease of communication.

Movers and Shakers: We will post the list of Several Movers and Shakers who make this initiative a throbbing success. Women, Budding Leaders, Technology Team and Operations team are few who make several things happen.

Our Founders (in alphabetical order of their first name):

Dr. Ajay Chaurasia, HOD Cardiology, Nair Hospital, Saifee Hospital, Mumbai Hospital, etc.
Dr. Anand Kawade, Pediatrician and Vaccine Authority, KEM Hospital, Pune and Vadu
Dr. Arvind Virmani, Molecular Scientist, Washinton DC.
Dr. Ashok Anand, Professor and Head, Gynecology and Obstetrics, GMC and JJ, Mumbai
Dr. Hemant Bhandari, Orthopedician, Mumbai Hospital, Mumbai
Dr. Pankaj Maheshwari, Chief of Urology, Fortis Hospital, Thane, Mumbai
Dr. Shashank Heda, Molecular Pathology and Technology Executive, North America

Humble Note: If inadvertently, we have missed a name, kindly bring it to our notice and we will credit them for their contribution. We request you to pardon for any of our omissions.

Trusting the Dragon Buddha

First, let us understand why not to believe the recent spurge in Pakistan’s peace initiative to India. Next, let us understand the Chinese conditional regression from Ladhak, and then, we know the Salami slicing in the South China Sea and the East China Sea.

Pakistan Initiated India Peace Process

After bitterly fighting with India from 1948 until 2020, Pakistan has a ‘sudden realization’ of having peace with India. Imagine a country (Pakistan) that divested all its resources to make its citizens impoverished and deprived of any moral or intellectual standing in the global polity of ideology and leadership. It is an established fact that Pakistan is the global cauldron and mother of all radical extremism and home for terrorism. Hegemony is within the moral code of Pakistan, to the point that it did not let the elected rulers from East Pakistan rule the country, thus dismembering its sovereign part. It is no secret that Pakistan acts as a vassal state embracing economic imperialism from China and economic dependency on other robust nations. Of course, it has fought a long war of 70 plus years with India, bringing the entire country to bankruptcy, chaos, and total failure. Can you imagine for what? Well, some amongst you may be thinking it is Muslim brotherhood, others may be thinking Kashmir. Well, you may be correct, but I will be tempted to think of ‘hegemony over India’ and what India stands for. Such is perfidy that builds their moral compass. In cell biology, apoptosis is defined as programmed cell death, where a cell kills itself as it gets old or becomes sick. In the case of Pakistan, it is auto-nemesis, or killing oneself with absolute (and obsolete) jealous ideology.

For India, peace is the definite objective, but do you believe a nation like Pakistan has a sudden change of heart for no reason? At least, I won’t? However, the vagaries of politics are different. I can understand the dilemma of Modi, especially when the global thought leadership insists on negotiating peace (not war). It is difficult to reject instead then embrace such a peace offer, thus the white feather from both sides.

Ladhak – Chinese Conditional Withdrawal

What is in a withdrawal when you are an aggressor? And imagine you put conditions on retreat. Imagine the audacity in such graceful withdrawal and now imagine India’s declaration of ignominious success and boasting of success by the Modi government, especially after the sudden attack on the power grid in Mumbai? Yes, we can count success as requesting intruders to vacate our land, or you can claim you drove them out by ignoring the conditional aspect. Why not?

The above are all Salami Slicing that you all are aware of. Salami Slicing is cutting slices or loaves from a piece of meat (to those naive readers). Does it sound familiar? You can be innocent and believe Pakistan and China, sing eons in praise of peace negotiators, or be prudent and plan your strategy.

Having provided a background to the Dragon Buddha, let me share additional strategies from CCP.

First Island Chain

Well, those deeply immersed in their own problems have little insight on what the first Island Chain means or the implications of losing those until it hits your kitchen and daily life.

There is a significant existential threat to your kitchen getting costly or your daily life getting disrupted with China gaining supremacy in the South China Sea and strangulating the shipping lanes to its own benefits. I will talk more about those implications in a later blog. However, let us turn towards the First Island Chain. Immediately beyond the Chinese international waters lies a chain of islands that belong to several independent nation-states from Brunei, the Philippines, Malaysia, Vietnam, Indonesia, Japan, and South Korea.

Diaoyu Islands and the East China Sea

Senkaku island belongs to Japan. China calls it part of their own territory and is referred to as the Diaoyu islands. The name is apt, “Do I Owe You?” ( 😀 I just coined it). I still have to research what they call in Mandarin, “Mine is mine, but yours is negotiable”. Fun apart, but that can be the mandarine name for almost all the disputed land, water, and sea territories presumed to belong to China.

Fun apart, let us see what else is at stake. Territorial aggression occurred when China stationed its Naval Carrier between Okinawa and Miyakojima, cutting off Japanese sovereign islands from the mother island. According to Toshiyuki Ito, professor at Kanazawa Institute of Technology and a retired vice admiral at Japan’s Maritime Self-Defense Force, “the area was temporarily subject to a situation where it was placed under the influence of a Chinese carrier.”

However, this indeed played well in upping the Aegis Air Defense Missile System between Japan and the US Aegis Air Defense would have died a natural death had it not been for the transient territorial aggression. It only proved proof of concept (POC) and why Air Defense is essential and critical.

Spratley and Paracel Islands

Picture Credit – Voice of Djibouti.com

It is no secret that China has developed complete control over these islands. You may be wondering, are these the only islands that these entire war regimes are likely to be fought? Let us add a few more like the Fiery Cross Reef, Subi Reef, and Mischief Reef are naval harbors with full Chinese Military encampment with fighter jets, bombers, and missiles.

War, not War Games
Traditional wars were fought with large drives of armies and big air or naval attacks. The last one was the theatres in the second Gulf War when Saddam was caught hiding in a drain pipe. Gone are those days if you are presuming wars would be theatres.

Current wars are Salami.

Besides, China has adopted the anti-access/area-denial strategy to keep out US aircraft carriers if conflict breaks out in Taiwan or the South China Sea.

Initially, current wars are small wins, followed by large sudden disseminating forces. These small wins are the so-called Salami Slicing, a type of guerrilla war. Temporary aggression and Anti access and area denial are just the probe games. Similarly, cyberwars and crimes, election interferences are transient strategies. The real war strategy and the actual war will be different. You may awaken a fine morning to see a significant truce that has turned the world upside down, do not be surprised.

The Xi within Me!

What would I do if I were President Xi Jinping? I would never fight a multi-border, multi-country war concurrently. I will identify my top priority, gain significant wins, and then charge lesser states. What is wrong if I make small wins against smaller states and keep the significant war at the end?

The End Game

Why not win with a thud rather than start with a boom? A right question, However, imagine if I am pushed back in Doklam, Bhutan, or Ladhak – I lose grace and edge over moral leadership supremacy. Of course, the Chinese army is hollow, but how do you win a war with a hollowed-out (gun) barrel? Never fight a real battle but use war strategies. Intimidation is a crucial pawn that, if knocked down, takes away many strategies.

So, what matters most to Xi at this moment is intimidation and domination, not over a small region like Doklam or Ladhak but the South China Sea.

Gaining control over the international waters responsible for 60% of global transit provides a choke point; not even a big container ship that got stuck in the Suez Canal would do.

Just imagine, China wins the war and imposes an extra 1% tariff on all the goods passing through these waters as one of the preconditions to a truce? If you bump up those numbers to 5, it would be a downstream avalanche. Now, imagine the impact on your kitchen, your daily dinner plate, and your daily living. Imagine, the most affected are the lower strata, which would catapult a revolt. How would any country contain an internal revolution? Well, keep them happy by sharing largesse.

Where is the largesse?

Rich will always get richer; that’s the history of good times as well as the pandemic and downtimes. Imposing any additional tax or burden will not cause any impact on life or living. It is the middle class who would bear the burden of this crisis.

Now, let us turn towards Ladhak and Doklam. Let us activate a two-front war with India. Isn’t it easy to win?

Do you trust Pakistan or China again?

Shashank Heda
Dallas, Texas

https://www.stimson.org/