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/

Best Time to Snarl

Covid has been a panacea, a boon for several of the authoritarian regimes across the globe. Several examples abound, and I want to briefly innumerate the credentials of some – 

Russia: Covid or no Covid, repression is the best weapon in the hands of the absolutely corrupt. Navalny is once again behind bars, irrespective of a reason. He would be behind the bar even for killing an ant. 

Myanmar: Suu Kyi is behind the bar for winning 86% votes, a direct threat to the Junta, who has 25% formidable votes forever in a 75% ‘must have’ to change the constitution. 

Hong Kong: Needs no mention, China found it the ripe opportunity to ensnarl and hijack the democracy, and convert it from One Nation Two System to One Nation One System. 

Turkey: Erdogan is losing ground economically (GDP is steadily falling), repression is quickly mounting, popularity is fast eroding and waning at even a faster rate, and nationalist drums beat loud sentiments. 

Syria: it never required any Covid, as if the political covid emerged in Syria, freedom has nothing to do with Covid. 

India: The economy is receding, but since Covid, it has taken a steep slide. Does it matter when Ladhak and Kashmir can rescue the throne? Bank privatization or Farmer’s protest will only spread the virus, or rather virus is the best to impose a unilateral agenda. Debates are no more political perspectives; those are the two polar sides of “For and Against” the nation. 

China: Is China better? At least they have nipped the bud of any rebellion in their Chicken Factory? What’s the Chicken Factory? Well, in poultry, Chicken always gets fed the best; they are always kept cozy, at comfort, in optimal temperature of rest, food, and oxygen. However, they do not have independence, like the free-range. They have a shelf life and so do the ordinary Chinese. 

Thailand: Oh, how can I forget King Vajroylonkorn without paying him an obeisance at his feet? Autocracy cannot breathe. 

Pakistan: It’s a unique country, of have and have nots, the radical and those being fueled to radicalism, never have respite. They work hard to maintain their business of radicalism, of continuously nurtured by the Military. A military continuously sucking the blood of the country. Well, those agnostic to all these are working hard too. Just that they don’t realize they are the lesser children of Allah. Peace be upon him! 

Spain: Catalonia will bounce back. It is waiting for Covid to turn its back. It will be sure. 

The list is long, let my flight resume, and I will visit more places to understand. 

Shashank Heda,

Dallas, Texas

One million Indian bank workers strike against privatization

https://asia.nikkei.com/Politics/One-million-Indian-bank-workers-strike-against-privatization

Stifling of Jack Ma

All along, I thought Jack Ma is the poster child of CCP. Propped up against Giants like Google, it was the local answer to the search engine giant’s global dominance. Developing an alternative to the algorithm-based search was the initial building block. Understanding the slicing and dicing of the data using deep learning, unraveling the patterns – local, national, and global, was fundamental to intelligence gathering. It added to the vast power of the CPC and its gargantuan apparatus.

However, having an independent corporate was a likely future risk. It’s a double-edged sword that can be used to size the enemy to the desired state or … And obviously, it is the same tool that could be used to change China’s political dynamics.

Jack Ma welded that immense power. The differences he expressed at the October 2020 business meeting was sufficient prodromal signs of features to evolve. If at all, the CPC invests wholesome energy for its stability (and possibly its sustainability). Several revolts are squashed, several muted, right in the embryonic stage.

Maslow wrote a fascinating hypothesis of self-actualization. This hypothesis of Self-actualization provides an interesting insight into the motivation behind the human endeavor, drivers, passion, energy that power human pursuit. CPC arrested that self-actualization and rise of the human through the echelons of these principles growth of growth, midway. Chinese society will see another revolution – that of intellectual, cerebral, and the cognoscenti revolting against this fettered structure of the expression. I am no Nostradamus, but if I understood Maslow, and if I have a little understanding of human independence and pursuit, it is possible to delay a revolt but impossible to avoid this emerging future scenario.

Stifling of Jack Ma is not enough!

Shashank Heda
Dallas, Texas

China asks Alibaba to shed media assets, including SCMP
https://asia.nikkei.com/Business/Media-Entertainment/China-asks-Alibaba-to-shed-media-assets-including-SCMP

Not Yet…Quad is Still a Paper Tiger

Redux Works Best Executed
Mr. Pompeo, The US Secretary of Defence under President Trump, said, “As partners in this Quad, it is more critical now than ever that we collaborate to protect our people and partners from the CCP’s exploitation, corruption, and coercion.”

The entire world is awaiting this formation amongst the strong nations from Asia to counter China and rise as an appropriate bulwark. China is an existential threat, a clear danger to South East Asia, Asia Major, and not just the continent of Asia but the entire global order. Unless you are a Chinese Communist Party’s (CCP) bootlicker, you won’t differ, even if you are the beneficiary of the largesse doled out at the mercy of the state-controlled capitalists.

Credits: https://twitter.com/rose_k01/status/1280354176720007168/photo/1

Quad thus becomes an appropriate response. It is natural for the major forces to align ( the formation being called Quad) and the smaller one to support this alignment. Obviously, China will distract this formation, confuse the smaller players by offering a lure, create ambivalence and ambiguity to weaken the alliance. However, its belligerence will unravel its intentions of not just hegemony but exploitative dominance and servile servitude. Expanding infractions, increasing internal schism, and exploiting the smaller nations have been the key intention since the start. This is evident wherever China has expanded its realms, Nation/states are realizing this reality. Those deeply drowned in debt, such as Pakistan, Sri Lanka, and few African nations, have no way out but to be servile and pander to the CPC’s China.

Too many fronts
China opened too many fronts simultaneously. Ladhak is not alone. However, China’s withdrawal from Ladhak has to be seen from this perspective. Indian’s belligerence and reaction to Ladhak only made it over. Thus, an elaborate articulation of forces encircling China.

However, China’s expansionist ambitions and its belligerence in the South China Sea, Taiwan, Hong Kong, Vladivostok, Khabarovsk, Ladhak, Aksai Chin, and Arunachal Pradesh (administered by Beijing and New Delhi, respectively). are not isolated events. To quote the Diplomat,” South China Sea (Vietnam, the Philippines, Taiwan, Malaysia, and Brunei) and the East China Sea (Japan).

Unraveling Five Principles of Peaceful Coexistence
These five principles include mutual respect for sovereignty and territorial integrity, mutual non-aggression, non-interference in each other’s internal affairs, equality and mutual benefit, and peaceful coexistence. Prima facie, these can be a sine qua non and a framework for all interactions for peaceful coexistence. However, despite signing this mutual agreement with a tiny nation like Bhutan, China renegade the understanding as it started building aggression in Doklam. India obviously countered and pushed back China. But only a year later, adherence to those principles would be tested in western Bhutan when Chinese troops began building an all-weather road through the Doklam Plateau.

China and South Korea
This lesser known maritime dispute over the Socotra rock in the Yellow Sea with South Korea is as interesting as the international law that dictates that submerged rocks cannot be claimed by nations as their territory. That simmering difference keeps festering along with other outstanding issues.

What is behind Baekdu?
China and North Korea have simmered same as its active volcano. Baekdu Mountain, as referred to in Korea and Changbai in China, has simmered over a long period. South Korea claims sovereignty over the entire Korean peninsula and is thus involved in this fray, whereas North Korea claims this as the birthplace for its supreme leader, Kim Jong-Il. To infuriate and rattle it further, China has proposed it as a UNESCO world heritage site. I feel, by denying ethnicity and its right to its identity, China is playing a bigger merciless game of reducing Korea to insignia.

Rhetorics to Red Herring
Never ignore the enemy and never be complacent of our strengths. I’ll add further, never underestimate our under-preparedness. There are several slips between the cup and the lips, there are several slips, the strategy looks great on the paper, but execution hiccups are a totally different ball game. It is a gargantuan exercise to coordinate these forces and work in tandem as a single unified organism. It will be this weakness that will take a toll. Putting the puzzle pieces into one place is different from having a complete organism working in unison.

So despite the exaggerated strength and the complacency from the union of the four nations, let a few more complex Malabar exercises pass through before we realize a semblance of strength from this union. Until then, it is wise to presume Quad is a paper tiger.

Shashank Heda
Dallas, Texas

The Quad comes of age: In pictures
https://asia.nikkei.com/Politics/International-relations/Indo-Pacific/The-Quad-comes-of-age-In-pictures

https://thediplomat.com/2012/12/baekdu-mountain-chinas-other-territorial-dispute/.

https://www.fpri.org/article/2020/07/china-territorial-dispute-bhutan/

Capitalist Democracy caves into State Controlled Capitalism

So, now every plebeian knows that China is destined against global values. It is not coronavirus; it is not the greed of acquiring land. It is not the theft of intellectual property. It is not the ambitious expansion of the BRI and make ‘the middle kingdom’ great again. It is not even the debt or vaccine diplomacy neither money-spinning planned obsolescence.

A. Tibet – a repeat of the West’s playbook

It started long back. Chinese forces moved into Tibet, a sovereign nation with hardly any military. The year was 1949. The Tibetan police and administration fought for almost ten years. Finally, in 1959, the young Dalai Lama (see of knowledge, which Dalai Lama means) fled to India. Almost thousands of Tibetans died in their struggle to keep their independence. Tibet lost its sovereignty. Han Chinese were transplanted to Tibet, and Tibetans became a minority in their own land. An alternate way of gerrymandering, i.e., changing the pattern of voting. So, if you initiate voting in Tibet, the outcome will favor China, not in Tibet’s interest.

The west willfully ignored Tibet.

It seemed like a repeat of their own playbook. Of whites displacing the Mezo American native Indians from their ancestral land – be it the Great American Highlands, the Mayan, the Olmec and Aztec in Mexico, or the Incas in Peru. It was a different land with its own cultural identity, far advanced, regal, and with its own rationale. Now, vanquished and destroyed completely. It is a story full of pathos.

The Spanish conquistador used the same playbook while destroying the Olmec, the Aztec, and the Mayan culture in Mexico and established a bastard generation. No, I am not using language. Actually, the native men were lined up and killed, and the native ladies were used as concubines. A hybrid progeny was born, and matriarchy established itself, replacing the native patriarchal culture. Portuguese repeated the same playbook in Brazil. Where the Europeans could not butcher, they plundered, and where they could not plunder, as in India, they established imperial order. Where that was not sufficient, they drugged. That is the China of 1820-1860.

Territorialism is not wrong

No one can blame Tibetans or the native Indians. It is their solemn right to protect their ancestral land. It is the equivalent of freedom or self-determination. Not that Mesoamerican natives were dumb, or the Tibetans were nubile. It is the barbaric marauding of locals using a little overpowering military technology. Gun and gun powder that was not seen or known to these cultures lost their destiny. In Tibet’s case, just a spiritual elevation of the culture that lost their ‘home and culture’ to eternity (remember, Bhutan is in a similar precipice).

The West, too, ignore Tibet. After all, China was reenacting the pages from the West’s own playbook. How could they take an objection against a (permanent) Veto power? You scratch my back, and I scratch yours. It was that simple.

B. Rise of a Demon (dragon)

Covid is just a simile; it represents several mutations that accumulate to evolve to form a variant and a deadly strain. By itself, Coronaviruses are not dreaded. We often get coronavirus infections. Covid is different; it is the survival advantage accrued through selective retainment of several mutations. Dragon, by itself, is not dangerous; it is the accumulation of dreaded mutations that make it a demon. China is not the concern; it is the perpetual accumulation of communist onslaught on its national identity that has resulted in a demon called China.

C. Wars live lopsided losers

If you are presuming that second world war and the loss of the axis forces, you are possibly close. However, I am alluding to the order and hegemony established by the winners that wrote the blueprint for global exploitation. The UN and its security council are a facade of exploitation. That veto structure itself is a grim reminder of the failure of the world order. China turned out to be a beneficiary of the Veto system.

D. Planned obsolescence

As though the west and the business never knew planned obsolescence. It was a willful ignorance towards such malpractices of building obsolescence into the design. Obsolescence is natural. However, planned obsolescence is the intentional insertion of weakness in products’ lifecycle to shorten their life. We, as customers, keep cycling our hard-earned money for buying products that dissipate faster.

Trade and businesses flourish while the commoner is depleted of the value for her/his earning. Cities, States, and Nations too run based on these taxes. Barack Obama instituted “Cash for Clunkers” after realizing the Gas Guzzlers were draining the dollar from the country. I am not sure if Biden or any President would initiate such ‘Cash for Clunkers’. Unlike the Gulf countries, which benefitted from Petro Dollars, China is the beneficiary of the “Obsolescence Dollar,” where the capitalist democracy willfully ignored the Chinese sly.

E. Free Trade and WTO

Free trades are a complex animal, and WTO is primarily the nemesis of the global order. Under the garb of expanding and widening their customer base, the West introduced and institutionalized WTO. As though a global institution was not enough, it institutionalized Free Trade Associations between select regions and countries. FTA’s wrote the storybook for the demise of local businesses. As a responsible nation, the US and other capitalist nations could have used retooling of the labor after the FTA vanquished their businesses. However, a nation dominated by capitalism left the small businesses to fend for themselves. Small businesses, farms, and back offices all vanished under the garb of the global village. The West again ignored. China turned out to be the major beneficiary.

F. Lip service

Europe, the US, and all advanced nations paid lip service to the African continent. The west and industrialized nations nurtured China to build a bulwark against (erstwhile USSR) Russia. While Africa, its people, its flora, and its fauna were celebrated in pictures and stories and as audiovisual gimmickry of altruistic passion. The capitalist West found it very hard to bring technology to this continent. They may now realize it was a mistake to house a global manufacturing center in one locale in hindsight. Multi centrism is just a realization from the Chinese debacle. It is an afterthought, not a humane yearning of the capitalist democracy.

As we see, it is the willful ignorance of the West and the Industrialized nations that resulted in a demon’s rise (dragon). By itself, China did little, the West nurtured it from the outset, and like Covid, it is dealing with the adverse outcome in every sphere.

Shashank Heda
Dallas, Texas

How the US military is preparing for a war with China
https://asia.nikkei.com/Opinion/How-the-US-military-is-preparing-for-a-war-with-China

Not farther from the truth

Why I don’t believe Chinese Research

A few weeks back, I wrote about being trolled by my own schoolmate while I differed with on India. Differing perspectives are normal in a democracy except in N. Korea, China, and totalitarian Russia. However, suppression of diverse views has come of age, and under the garb of nationalism, national identity, and sensationalism, right-wing radicalism is becoming a mainstay. Right-wing radicals have rightly capsized and exploited the suppressed sentiments such as nationhood and nationality. BJP as a polity is dominating the thought process too. That is exactly what’s driving China’s Xi. Citizens can do whatever they wish but need to align with the identity espoused by a core group from the dominant outfit. It is exactly for this reason that I do not believe in any Chinese research. You may find a Sinophobe in me. However, let me admit, I am a Communist Party Phobe. The ordinary Chinese are just like us, driven by sentiments, apprehensive, somewhat insecure, somewhat reclusive, and often intimidated by the political class and unsure of their future, struggling to bring their families. They are exactly like us, and I can identify with them since I am one amongst them.

Does it Matter?
What happens with the Chinese Citizen does not matter to us. We willfully ignore until we face an onslaught on Doklam, and Ladhak. It does not matter until we lose power in Mumbai from cyberattacks that originate from China. How would a democracy prevent all such happening of historical proportions? A totalitarian voice can also be part of democracy, the same way Indira was for India. However, democracy provides a way out from such a totalitarian fortitude and mess. Multiple voices and replacements of dominance bring a better perspective. The recent past provides enough evidence that democracies are no panacea, but they are better institutions than the ones dominated by a single voice.

Unity in Diversity
It is not a Congress Cliche; that’s the backbone that forms the nation’s DNA formed over thousands of years. It definitely is not 80 years old.

We all know the amazing history of India. Waves over waves of immigrants migrated and settled in different parts of India, calling it their motherland. Culture, faith, and foundational ethos emerged, survived, and flourished in India. Genomic amalgamation, too, happened with the passage of time. This gave rise to a polity called Hindu, not a religion but a way of living, an art of living. Just ask yourselves, how can a mongoloid race from North East (Seven Sister) identify themselves with the drastically different Dravidian identity down in Southern India? The only mystic thing that binds is Hinduism (not a religion but an identity formed from a living polity).

There are immense stories of plunder and numerous stories of the lost land. That is definitely painful, but unfortunately, the land is not Hinduism. People make that identity. The nation has a checkered history of astute rulers who united these fragments, and there are numerous examples of shortsightedness that created these fragments. However, as I reflect on the passage of time, that is a natural cycle, and the identity has survived despite the tumultuous history of treachery and trepidations.

That very identity is under threat. Just imagine, a person like me, who is now a citizen of another country, is afraid of writing on the farmer’s protest.

Does it ring the bell? Or this Individual Freedom Group from a distant land will be called Deshdrohi and slapped with sedition? Yes, we are heading towards a totalitarian state, and that yearning is a palpable need of the plebians.

Shashank Heda
Dallas, Texas

India is now only ‘partly free’, says global report
https://www.bbc.co.uk/news/world-asia-india-56249596

The case of a swollen node?

(Note: this message is drafted for the nonmedical audience) 

What’s a swollen node? Lymph Nodes are your primary line of defense leveraged by your inbuilt immune mechanism. Everyone has it (rarely are people born with a defect with the immune mechanism). 

Suffice to say, whenever you have an infection or hurt in that part of the body, the lymph nodes enlarge to contain and control the infection. 

Illustration Credits, Wiseegeek

The same happens when vaccines are given. With Moderna, the incidence of ipsilateral node enlargement is 11% to 16% with a first and second jab, and with Pfizer, it is significantly less. Johnson and Johnson, in its emergency approval document, mentioned none. 

Both Covishield and Covaxin uncommonly initiate lymph node enlargement. Such uncommon outcomes are generally in the range of 1-3%. However, with any vaccine, as more data accumulates, the figures are likely to change. 

Why does it matter? 

Two things are crucial with swollen nodes. First, they are sometimes tender and or painful, with resulting discomfort. Most enlargements are self-limiting and subside on their own. However, occasionally few persist. Of course, it goes without saying that you need to consult your doctor. 

The second and most crucial aspect is the persistence of nodes in a female patient that may need a mammogram. Sometimes these nodes are revealed not clinically but on an accidental CT or MRI. It becomes a cause of concern that needs further workup, but in most cases, nothing significant comes out after investigations. However, it is best to investigate despite knowing the pre-investigation probability. 

Illustration credits: WebMD

Learning lesson: 

  1. Beware of an enlarging lymph node on the side of the vaccine shot. 
  2. Generally, these are self-limiting and will subside eventually.   
  3. If swelling persists or keeps enlarging, it is pragmatic to get investigated.

Commonly used terms in the illustration below

Illustration Credits: Medicine Net Inc.

Shashank Heda, MD

Founder and Chief Executive

CovidRxExchange 

Email: info@covidrxexchange.org

Phone: +1 (650) 996 6745

(A global nonprofit organization for disseminating expertise and insight in the medical care of COVID patients)

Mapping The Minefields – 1

Recently, China started expanding into Cape Verde, an island deep in the Atlantic ocean, far away from its borders. To make it simple, closer in the range to strike the US. China is continuously in dispute with all its neighbors. Be it Russia, Mongolia, Vietnam, Nepal, India, Cambodia, Myanmar. Wherever, it land or maritime borders reach, China has a claim. Modus tollen is simple – find a reason – geographic, historical, or whatever, it should become Chinese land. Thus, China’s claim over land within Nepal dates back to 1962, Vladivostok to 1860, Tibet to 1788, etc. I will publish a series of articles on these land encroachment, disputes, and the resolution. https://mymilieu.org/2021/02/26/mapping-the-minefields-1/

(This interesting piece of Chinese nationhood is inexorably less understood. It is interesting to know how China is indulging in land grabbing with every other nation with which it shares the border. I will cover this topic in multiple parts. I will upload cartographic pictures on my blog site).

Competition is always encouraging, especially when it happens to dismantle a 75-year-old hegemony over global affairs. However, anyone will abhor and detest a winner from the competition to be dictatorial, repressive, and regressive.

Are we biased?
Let us hypothesize that we are biased before giving the benefit of the doubt that we are not. Let us analyze our internal bias before we proceed and presume we are not anti-China. It is possible; we have been capsized by Stockholm Syndrome (please read my earlier blog). Several indicators support Chinese Machiavelli. These range from territorial aggrandizement, guzzling raw resources (such as rare earth, premium metals, and upstream river water), South China Sea encroachments, illegal occupation of Tibet, Xinjiang, and Hong Kong, persistent threat to the autonomy of Taiwan, technology (IP) theft, currency manipulation, deftly planned obsolescence, economic exploitation of vulnerable nation and repression of internal human rights. Am I still biased? Well, I have reasons to support that I am not. Yes, I would have been guilty of a bias had I mentioned Ladhak, Dokhlam, encouraging Pakistan terrorism, North East Insurgency, or Kashmir. However, I removed these confounding factors. Suffice it to say, at least I am not biased.

A revival of Great Sly Silk Road
Well, every segment of the border is defined by a different historical year. Nine dash, or Tibet or India, Kazakistan or Vladivostok

The Great Wall of Sand
Nine-Dash, sometimes also called Ten-Dash or Eleven-Dash, depending upon how long and deep you want to extend the conflagration. If you want to claim Spratley, Paracel, and the Pratas Islands, you can debate any approach to settle the scores. Finally, the brute (and now V-Brute) force will determine the Straits of Taiwan’s outcome. Remember, the benchmark year for China’s claim over the South China Seas is 1947/1949.

Tibet – A repression that knows no bounds
Before the 1949/50 Chinese invasion, Tibet was an independent nation, with consulates in Lhasa. Tibet had its national flag, currency, stamps, passports, and a small army. Sensing the Tibetan army’s weakness, China intentionally transferred Hun Chinese into Tibet around 1949/50. For almost ten years, Tibet fought for autonomy, and finally, China occupied Tibet in 1959/60, driving out The Dalai Lama and his monks and destroying their monasteries. According to the People’s Republic of China, Tibet was ruled by the Qing dynasty in the 16th and 17th centuries. However, after that, it was Nepal that ruled Tibet from 1788. Irrespective, the gerrymandering of Tibet by mass transplanting Hun Chinese amounts to a serious violation of the Fourth Geneva Convention of 1949. The Dalai Lama claims that China has killed almost 1.2 million Tibetans since its occupation. The Chinese claim that they have built infrastructure and increased the GDP in Tibet to 30 times. My question to you – Will any amongst you like Chinese infrastructure and GDP at the cost of your freedom? Remember, the benchmark year for the claim of China over Tibet is 1788.

Vladivostok, the Eastern part of Russia, adjacent to China’s eastern part, is claimed by China. Why not? The logic is simple: if you pull an imaginary line on China’s northern border, Vladivostok falls within the Chinese territory. All China has to do is being ingenious to support its claim. History indicates that until 1860, Vladivostok was part of China. However, after the second opium war, Primorsky Krai (an equivalent of a state) and its capital were administered by Russia. Thus, it is just the acceptance of modus-tollen that underpins China’s claim over Vladivostok. Remember, the benchmark year for China’s claim over the Vladivostok is 1860.

Nepal – Rui Gaon, Tegha and Annapurna, now part of China
Up until 1962, the residents of Rui Gaon (translated village) were part of Nepal. The residents there paid revenue (tax) to the district in Nepal. Thereafter, China simply moved the pillars and claimed them to be part of Tibet. Now, Rui Gaon (village) is part of China. The picture mentioned below has all the flashpoints between Nepal and China. Just imagine a reticent Nepal as a belligerent state and provoking a monk (China). One can safely guess that the blue lines will eventually become the future flashpoints between China and Nepal. Remember, the benchmark year for China’s claim over the Rui Gaon, Tegha, and Annapurna is 1962.

The vision of a great nation rests on territorial expansion. The road to connect this resurgent middle kingdom is the Silk Road, also known as the Belt and Road Initiative; the land route connects to the consumer base in Europe. There is always a surplus and scrap; what do we do? Never through the scrap, sell it to Africa. If they don’t have the money to pay, well sell now (on loan) and book the profits later. Truly not an ingenious model but definitely a sly model.

Trumpism in hindsight
I was always mesmerized by the raucous noise by Trump against China. That was the best we aligned. Never realizing that too was shallow and superfluous. While Trump indulged in sensational knee-jerk diplomacy, the state department continuously monitored the Chinese global growth points, irrespective of Hambantota (Sri Lanka), Gwadar (Pakistan), Djibouti, or Cape Verde. It was willful and criminal negligence towards these Chinese Growth Points. Why? When you nominate people with thin resumes or those from your donors, you sacrifice the higher intent of protecting the land. It is willful, and yes, it is criminal because the country, in general, has to face the aftermath of their inadequate decisions.

Cape Verde – An infrastructure Diplomacy
I never knew there is an island country called Vape Verde, almost in the middle of the Atlantic. China helped build a football stadium, a presidential palace, and another $60 million worth of infrastructure investment. So the US has awakened (though under a different administration) to another growth point on the west of Africa.

Gradually and steadily, China is building a minefield for a future confrontation. If we forget history, we are doomed to repeat the mistakes of the past. Material success is not a measure of wisdom, and China seems to have that insight.

Great power competition: the US boosts Africa diplomacy on land and sea
https://asia.nikkei.com/Politics/International-relations/Great-power-competition-US-boosts-Africa-diplomacy-on-land-and-sea

https://www.bbc.com/news/world-asia-pacific-16689779

https://www.culturalsurvival.org/publications/cultural-survival-quarterly/legal-status-tibet

https://freetibet.org/about/china-argument

Watch ‘Vox Borders’, https://www.imdb.com/title/tt9563892/

Manage COVID After A Recess

While the US, EU, UK, Brazil and South Africa were smoldering with the newer variants of COVID, many in India thought COVID was done and dusted. Life was back to normalcy, hardly realizing that India was in the same stage of ignorance as it was exactly an year ago. COVID is back, and this time it will be with a vengeance. What do we do now? I have discussed the relevant principles so that you can make changes to your lifestyle in accordance with the emerging threat from the newer variants.

A few weeks back, when I talked with several Commissioners and Administrative officers from Maharashtra, Tamil Nadu, and at the Center (Delhi), the palpable feeling was that Covid is “done and dusted”. Life was back to normalcy, and all cautions were out of the window.

A few weeks back, when I talked with several Commissioners and Administrative officers from Maharashtra, Tamil Nadu, and at the Center (Delhi), the palpable feeling was that Covid is “done and dusted”. Life was back to normalcy, and all cautions were out of the window.

I cautioned that it is not yet out, and I shared a blog called a tale of two worlds (link shared below) along with a few reports on the raging pandemic in the US, EU, UK, Brazil, and South America. The ignorance was high, and most felt that they had achieved herd immunity. ICMR reports indicated 24-26% national seroprevalence; Chennai’s reports indicated 40% seroprevalence, which again meant inadequate herd immunity. However, facts are generally relegated, and sentiments take precedence. Once again, I wrote another blog on Herd Immunity (link cited below). Always remember TWO MOST principles of herd immunity –

  1. The entire population should be 60-80%
  2. The epitope (in this case, the viral protein) should be constant, not changing

It is in the nature of this virus that the structure is changing every few weeks. Another blog that was written a long time back on this nature of virus was shared with the medical community. To summarize, the covid virus has a defect with RDRP, an enzyme that helps in multiplication. It creates typos, like the one we unintentionally do while typing. However, with covid, those typos change the structure (changes to S or Spike protein is an example) that renders the immunity from previous infection less effective.

Thus previous infections or vaccines are likely not to provide the anticipated immunity. Besides, this virus’s immunity lasts for 3-6 months, as against the smallpox vaccine, which lasts life long.

So, what do we do next?

  1. Should we stop all our social activities?
  2. Should we stop interacting with our professional friends, coworkers, staff, and others?
  3. Should we quarantine and put ourselves in lockdown?

None of these are practical and pragmatic. Before I tell you what is appropriate, let me share what is inappropriate. Yesterday, I talked with a prominent businessman from Nagpur. He said he uses the alcohol-based hand cleaning solution, cloth-based face masks, and takes a shower after returning home, and puts the laundry clothes.

All except face masks are not required. This is an airborne virus, not a virus spreading through fomites (bugs on your clothes or body via touch).

What is airborne and aerosol? When an infected person sneezes, he/she blows almost over 50 million copies of the virus in one bout of coughing/sneezing. These are invisible and disperse in the air around you. An aerosol is similar to airborne, except that you can see those droplets.

Either way, noninfected people end up inhaling those viruses and ultimately increase their risk of getting infected. There are several factors involved between the sneeze/cough bout and infection by normal people. Closed space versus open space influences the outcome. Similarly, centralized air conditioning circulates the virus via the duct system, thus exposing people in other contiguous areas.

Using n95 or similar masks is THUS CRITICAL. I generally add another layer of the surgical mask when i presume exposures are likely to increase.

Social distancing helps, but it is not a panacea. Just imagine, I am not on the same floor as the infected person but connected via centralized air ducts. Will it help? No. I am logically in the same environment though I am in a different place physically. That also means you have to focus on the principles and not just the practices. Understand the principles and act accordingly.

Lockdown or Quarantine?
The most considerable toll this pandemic has taken is from lockdown. Even during the first lockdown implemented in March/April 2020, I was firmly against global lockdown. The answer is never global lockdown; it is always micro lockdown.

What is Micro Lockdown?
Only lockdown that part of the city or segment where the incidence is likely to be high. However, even micro lockdowns are easier said than done. It is difficult to identify a community of infected (but asymptomatic) people and quarantine them against a traveler arriving outside (by flight, vehicle, or train). Remember, once lockdowns are implemented, they ideally last 3-5 weeks, unlikely to be gone in one week. However, it is best to contain and segregated those suspicious of carrying the virus, be it communities, individuals, or activities.

Curtail all Social Activities
Certain activities are unavoidable, critical business, social activities (marriages, deaths, illnesses, and adverse events). However, remodeling our way of interaction is always possible. Certain principles are absolute and non-compromising (wearing a good quality mask); yet, remodeling can be done for the day’s activity, the place, the interaction, etc.

Let us understand those and tailor our activities.

Dr. Shashank Heda, MD
Founder and Chief Executive
CovidRXExchange
(A US global non-profit initiative for disseminating medical expertise and insight; working for Covid since March 2020)

Links to the blogs below –

If only we proactively spread the message within our network, engage in an active dialog, resolve the misgivings around the vaccine, start Fastrack the process to curtail the virus. Our ability to bounce back, as a nation and as a community, depends upon how we counter the virus. https://mymilieu.org/2021/02/01/evangelizing-vaccination/

The variants with the infectivity, implications on testing, therapy, and vaccines. https://mymilieu.org/2020/12/26/emergent-variants-and-infectivity/

That provides a simple explanation of how vaccination will halt the spread of the virus. https://mymilieu.org/2021/01/28/a-triple-whammy-variant-vaccination-and-complacency/,

It is an ultimate hope that the vaccine provides herd immunity or the virus comes to a state of symbiosis with humanity. Luck is never the best strategy, but it had to happen. We wish to stumble across a variant that is as good as Common Cold, leaves minimal health impacts, and possibly with minimal mutations to stabilize. In the search for this haplotype, I shared this perspective https://mymilieu.org/2021/01/10/in-search-of-a-haplotype/

https://mymilieu.org/2021/02/06/covid-a-tale-of-two-worlds/

https://mymilieu.org/2021/01/28/a-triple-whammy-variant-vaccination-and-complacency/

https://mymilieu.org/2021/02/01/evangelizing-vaccination/