The Delta (Plus) Variant

We saw Delta Variant in India recently. It almost engulfed the fire like a dry forest, about to simmer.

It is highly transmissible, deeply morbid, and highly fatal. It devasted families, took away a lot of near and dear, and maimed several left behind, just like a tornado.

One more thing that is noteworthy – it came like torrential mansion rains, slashed, wiped, and flooded the streets, and leaving behind vast devastation, it left away with the same agility.

One difference, though, monsoon follows a solar cycle, virus follows its mutation cycle. Will it strike again? When will it come again? Will it strike with a vengeance?

Some said we did our best, others said did we? Let not the virus divide us into polar extremes. No good predictions will help, but the answers are within the virus, the hosts and, the milieu that we create, live, and exist exists.

Can we truly predict? Possibly yes, it may not be easy, but we can try and be in the ballpark.

What do we do?

CAB, Covid Appropriate Behavior is the best safeguard next to Vaccine (are the Vaccine Nah sayers around, 😉).

Emergency preparedness is next in order. We, at CovidRxExchange, are working to build Emergency Awareness based on our 3×3 model and the revamped Extended Life Cycle Model.

Do you want to join? Nonmedical folks, too, can do a lot. It’s payback time. Can you step up to give back?

Our 4600 doctors (spread out across multiple states in India and overseas) from CovidRxExchange will be more than eager to get a nonmedical technocrat on their team. We will map you to the areas of your choice. It will be a short assignment, and we can work with your employer to recognize your voluntary efforts (We are a registered nonprofit organization). You can volunteer at your convenience; a few hours per week would make a difference.

Let us know!

Thank you

Sincerely

Dr. Shashank Heda

Dallas, Texas, US
Founder and Chief Executive
CovidRxExchange (a global nonprofit initiative focused on disseminating expertise and insight in the medical care of Covid; We are working relentlessly since March/April 2020).

Beyond the Phylum

Beyond the Phylum

This is the only space where I share my politically resonating ideas on Covid. On all CovidRxExchange forums, I stay apolitical and nonpartisan. From the onset of this pandemic, I am certain that SARS CoV2 is a lab-made virus. Remember the Green Revolution in India (1964 onwards)? Grain self-sufficiency was possible because of the emergence of the hybrid variety (gain of function).

Whether ‘Gain of Function’ was used to develop a weapon of mass destruction or it is an accidental spill will soon be unraveled. However, I want to point few glaring facts and offer few questions –

  1. The pandemic is extremely well controlled in China, at this moment and in the last several months. Of course, the Chinese have not stopped any human interaction except that they maintain Covid Appropriate Behavior (CAB).
  2. The pandemic has taken a significantly devastating toll on the US, the UK, Brazil, and now India. Of course, these are democratic countries, and people enjoy the right to their choices. Thus CAB is a personal choice that has influenced the inundating incidence of covid.
  3. China started vaccinating their citizenry way back be in Sept/October, after the initial results from clinical trials. Of course, the world did not and will not believe if the data is feigned, suppressed, or manipulated. However, if we go by the success of the vaccine, it seems their vaccine worked successfully in their own citizens.
  4. China clamored in the global marketplace to sell its vaccine. No one took their data seriously though scientific literature published it as facts, and media published it as news.
  5. Do you know retroviruses integrate into our genome? Do you know, the human genome has pieces of viral DNA integrated into our genome? Those regions are called introns; they do not express (presumably), and thus we show no obvious viral proteins.
  6. Below, excerpts from BBC Brazil and Chinese Vaccine. Brazil is not the only country that bought the jabs from China; several countries have Chinese-made vaccines for their citizens. The rich or the ones who understand vaccine nuances avoided Chinese-made Vaccines. The first-world countries are a testimony.

My perspectives

If the virus is lab-made, China had the complete genome from the onset. It also understands the protein (moieties) and the (host) receptors and the mechanism of action and pathogenesis.

It is this understanding that propelled China to develop the vaccine before the world could do it. It thus protected its citizen using this vaccine.

Questions

  1. Why were facts suppressed during the early course of the disease??
  2. Is China giving the same vaccine to other countries?
  3. What if the Chinese vaccine has iatrogenic DNA that integrates into the human genome?
  4. At the cost of being paranoid, does China know how this integrated DNA will impact the foreign citizenry?
  5. If it has truly shared the same vaccine that China gave its citizen, was a special deal made other than the commercial aspect of the jabs?

It’s complex and confounding, but trust me, anything with China gets you perturbed, if not confused or obfuscate. Its nefarious ways of dominating humanity are above the natural laws of altercations and interactions. I call it ‘generation advantage’, that you and I will not be able to grapple or understand. CCP ( Chinese Communist Party) is a scourge to humanity, not that humanity was ever kind to its phyla. However, this is beyond that.

Shashank Heda
Dallas, Texas

Note: These views are my personal views, have to association with the nonprofit I work for. The blog is not validated for typos or grammatical errors.

Brazil Covid: Deaths plunge after town’s adults vaccinated
https://www.bbc.co.uk/news/world-latin-america-57309538

Vaccination and Covid Second Surge Wave

Vaccination and Covid Second Surge Wave

The second wave is not just riding; it has mauled and incapacitated life significantly in several states across India. Collectively, our success during this pandemic will be defined by our individual efforts to stop this pandemic. 

So, where are we failing, and what do we do? 

Initially, let us understand why we are failing. Noncompliance with precautions is the primary reason for our failure, followed by complacency. Another reason is nonconformance to standards and presuming we are smarter than established practices, and indulging in Jugad. Let us avoid that this. 

  1. Feeling helpless and : This second surge, with its massive hospitalization of the younger population and inability to find medical/healthcare resources, is a major cause of acute and debilitating apprehension amongst those who are infected recently. 
  2. bored and 
  3. Feeling scared and apprehensive:

Thanks, Nandita. Below is what we discussed. 

Problem Statement:

With the massive resurgence of Covid, healthcare resources are inundated and are under significant stress. It has become common to hear that hospital beds are not available. Hospital beds are not available, and newer faces of clinical problems demand clarity on clinical pathways, decision making, and standardizing care. Hospitals and healthcare facilities are not available. We want to ensure a contingency model that supports remote care, aligns and with the best practices, and concurrently accommodates the limitations and constraints with the clinical settings. 

With the massive resurgence of Covid, healthcare resources are inundated and are under significant stress. It has become common to hear that hospital beds are not available. In addition, emerging clinical scenarios mandate clarity on clinical pathways, decision making, and standardizing care. Where hospitals and health care facilities are not available, we want to ensure a contingency model is created. This contingency model will support remote care, align and support the best practices and concurrently accommodate the limitations and constraints with the clinical settings. 

We are constituting a committee to do due diligence and update clinical pathways and standards of care. Existing guidelines from national and international eminent professional bodies will be reused (where appropriate) or refactored (where needed). We will create content based on gaps in the existing body of knowledge. Content brought from other sources will be credited based on Creative Commons. Content created collectively under CovidRxExchange will be under Creative Commons. 

Join our global pool of experts across multiple regions and countries to capture and refine the clinical problems from your settings. If you wish to join the team as a contributor, we will add you to our three-tier team structure. with adequate support to consume the least amount of time. A RACI will be drafted, and ETA will be tagged to tasks/activities accepted by the contributors (panelists/experts). 

We will publish a plan, progress, and a draft version circulation at the earliest to address the emergent issues. Key issues – 

  1. Clinical Pathways and Disposition
  2. Standardization of Care under nonavailability of resources or resource crunch (nonfinancial and financial). 

Those interested as contributors are welcome to join. Please share your profileexperience within Covid, and contact information on 

Info@CovidRxExchange.org

Or Join Slack on 

What do we do now that we are vaccinated?

Question: Can I visit extended family and friends? 

Some people have been vaccinated against coronavirus, but the risks associated with spending time around others outside of your household haven’t been fully eradicated. 

The current second surge in India, is an example. The 

“The tough part is that right now, I think that we all still need to be vigilant in everything we do, whether we’re vaccinated or not,” said Dr. Ada Stewart, a family physician with Cooperative Health in Columbia, South Carolina, and the president of the American Academy of Family Physicians.

“It does make a difference if you’re vaccinated, especially if you have family members that are vaccinated and then you all can gather in a different way,” Stewart said. “So, there is a slight difference, but everyone still needs to follow the public health measures recommended from the (US Centers for Disease Control and Prevention).”

What to do if you’re vaccinated

Fully vaccinated people can “visit with other fully vaccinated people indoors without wearing masks or physical distancing,” the CDC has said. They can also “visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing.”

Fully vaccinated people can visit unvaccinated family and friends, but one household at a time, CDC official says. But there are exceptions. If, for example, you’re fully vaccinated and visiting people who are unvaccinated and at high risk for severe disease or death from coronavirus, you should wear a mask and practice physical distancing.

Also, avoid attending medium- or large-size gatherings where you might not know the vaccination status of every person. If you’re vaccinated but have unvaccinated children, know that “we just have to be careful when we’re around them,” Stewart said. “Wash our hands, wash their hands, wear the masks.”

Create ways to help your children remember how to be safe, such as setting up chairs as “physical reminders that going beyond this is more than 6 feet,” said Regina Davis Moss, the associate executive director of health policy and practice at the American Public Health Association.

Tips for unvaccinated adults, grandparents and children

For unvaccinated people who want to visit unvaccinated extended family, virtual gatherings are still best. However, if you’re unvaccinated and choose to visit unvaccinated family, everyone should be outdoors, wearing masks and staying at least 6 feet away from one another.

How vaccinated grandparents should approach visiting loved ones now — advice from Dr. Wen

Whether you’re indoors or outdoors, you’re more likely to contract or spread coronavirus when you are in close contact with people for a total of 15 minutes or more over a 24-hour period, the CDC has said. Therefore, consider the amount of time you’re spending together and the types of activities you do as well, said Krystal Pollitt, an assistant professor of epidemiology at the Yale School of Public Health and an assistant professor in chemical and environmental engineering at the Yale School of Engineering & Applied Science. In addition to coronavirus spreading by respiratory droplets, coronavirus can transmit through air as well.

“Maybe avoiding a meal inside, but still doing that outdoors,” Pollitt suggested. This applies to vaccinated people visiting unvaccinated people — who are at higher risk of serious illness or death from coronavirus — and to unvaccinated people in general.

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Fully vaccinated grandparents can visit one household of unvaccinated children and grandchildren at a time, indoors and unmasked, if none of them are at high risk of severe disease.

Grandparents who want to see unvaccinated grandchildren from different households “should see the grandchildren separately or do it all outdoors” to mitigate risk, said CNN Medical Analyst Dr. Leana Wen, an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. “They should not be mixing them indoors.”

On Vaccine Challenges

Unfortunate but true

Some are presuming this to be a promotion of one country’s vaccine over the other. It has little to do with Brexit. Transparency is crucial. None of the Chinese vaccines had enough transparency. Consequently, they fell through. Vaccines from Russia Sputnik) too had a similar fate until data was under scrutiny.

It is condemnable to see how manufacturers try to make money using national, regional politics. Pharmaceutical Vendors are meant to safeguard their interests. That’s where regulatory and approval bodies come into the picture. They are the ultimate guardians of the system. I hope and trust that every regulatory organization upholds the highest standards of care, and I hope every country provides that political independence to these bodies (without pressurizing them).

Efficacy apart, this video by VoX is intentionally leaning towards J&J. Let me share with you why?

  1. Pfizer was not done in the US alone. In The clinical trials were also done in other countries, including Germany (a major clinical trial base).
  2. The variants prevalent at that moment are ideally captured from the wild and selected for antigen presentation and vaccine development. Pfizer does have the mutants such as N501Y (B1.1.7/UK), which is the base for B1.351 (South Africa), or P.1 (Brazil). The viruses will continue changing genetic composition and thus likely to be less immunogenic as time advances. All vaccines, including J&J, are likely to see this happening.
  3. The intent of a vaccination is to prime the immune system to build a fast and efficient response (with the least reactogenicity). All these vaccines achieve that. They prime your system. J&J is no exception.

The Vaccine Manufacturers are pushing their own vaccines aggressively, leveraging commercials and using promotions like Vox. We, as individuals, want to avoid falling into their internecine advertisement war.

Summarily, let’s take any vaccine that comes your way, and remember, you will have to take further doses eventually, after a few months.

The Tsunami (Wave) of Covid – What can we do?

The Tsunami Wave of Covid – What can we do?

I am in touch with all the different corners of the country. The unsurmountable fire of Covid has engulfed every nook and corner. The stories of death and desperation are so common that not a single call is devoid of the deep realization of the country’s anguish and pathos.

I realize two distinct sets of institutions, and I see a distinct dynamic response from both these institutions. First, the Government as an institution and second and foremost, ‘WE the People’.

Let us talk about the Government since we so much believe in our sense of entitlement. I am taking a neutral position and not siding or opposing with intent by design.

There was a sense of complacency and pragmatism in diverting the vaccines as well as the medications such as Remdesivir or Favipiravir to other countries that were suffering. In today’s integrated and dynamic world, national interests are subserved by commending global leadership. After Indira, we have an astute leader in Modi who understands this and has the knack and panache to drive that.

The age of vaccine diplomacy

During this age of vaccine nationalism, when most western powers huddled into vaccine nationalism, Modi took a moral stand of supporting the global cause. We have to understand, I did not see a sense of abandonment but a vision to expand and extend the national cause.

Corona – A global Slayer

SARS CoV2 has the enigma for a surprise attack and ambush. It’s different, and it has caught all by surprise the advanced nations and the advancing nations with the same level of temerity. Estimation models, intelligence, and expert instincts have all failed across the spectrum – from advanced, advancing, to those making attempts at advancing their nation.

India’s story is very distinct and different, and a significant onus lies with us as ‘We the People.’ First, it’s a massive country with a population of over 1.3 billion people. Next, it’s a free democratic country, where an extra sense of entitlement prevails. To add to this, it’s highly diverse, geographically, culturally, ethnically, ideologically, and politically and economically. With such a melting cauldron of diversity, it becomes incredibly challenging to provide a standardization of care across all strata.

We the People

Why are we hoarding? Why are we preemptively reserving resources when those are not indicated? Why are we black marketing resources despite knowing the crisis hours? Where is our faith in equitable and fair distribution when we break the queue and create pandemonium to grab necessities? Barring a few, have we ever shown trust, and confidence in the processes rather than bypassing those?

In a country where the rights belong to us and where I have bequeathed morals as someone else responsibilities, how can we expect our Government to function orderly and deliver?

These are pandemic times, and these are times of pandemonium, but definitely not armageddon. Hope and faith are the foremost things during a tempest. Let’s ride through this in an orderly way. Let’s trust and activate our inner moral compass that follows that will guide us with our responsibilities and our rights. Let’s follow an equitable process and trust fair practices, and most importantly, let’s pray and practice patience and activate our inner endurance to bear this calamity with courage and patience. Let us focus on us as the prime object of change, and a change in the system will follow.

I wish an early recovery through these tormenting and tortuous times.

Shashank Heda, MD
Dallas, Texas

https://pib.gov.in/PressReleasePage.aspx?PRID=1712710

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/