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Boosting the State of Indian Economy

GDP trend indicates the health of any economy. The economic slowdown is often cyclic and a fact of life. However, the economic woes are all-pervasive and understanding the root causes help in providing insight on how best to fix. Individual countries have different problems, comprising different patterns. Thus the root causes can be broadly categorized into a pattern and individual factors specific for the country and its economy. Often, there is a shared thread between the integrated global market place. Identifying the patterns and the specific individual factors will help in putting up a strategy for revival.

This article articulates the need for a solution within broader problem space for India, which has fluctuated economically from ‘at risk’ (2013), ‘expansion’ (2016) and now again ‘at risk’ (2019). This blog is not exhaustive and does not go into a detailed root cause analysis or detailed solution building exercise. In this article, the author has provided a select set of solutions that would boost the economy, provide opportunities across multiple sectors and ameliorate the problem of the continuing slowdown.

Word Count 2294; reading time 8 – 11 min.

Economic slow down is often cyclic and a fact of life. Slowing down or crash landing of the Indian Economy is an increasing chatter on the internet. However, a closer look will reveal that the recessionary phenomenon encompasses most major economies including the US, China, Japan, Germany, the UK, France, Russia, South East Asia (the so-called ‘Tiger Economies’ of the 2000s), Brazil, Turkey, and oil-rich Gulf Nations. Latin American countries such as Venezuela, Brazil, and Argentina are acutely going through this recessionary distress with revolts and change of ruling Governments. Venezuela is undergoing severe inflation called stagflation that is spreading the contagion across the borders. Poland and Canada are amongst the only few countries that are showing flying colors despite the adverse global economic headwind.

Nations such as Pakistan, Sri Lanka, and many African countries, especially those who have subscribed to the String of Pearls (SOP), Belt and Road Initiatives (BRI), Regional Comprehensive Economic Partner (RCEP) and the 54 nations of the Africa Continent Free Trade Agreement (AfCFTA) will face a massive financial challenge while servicing the burgeoning Chinese loans. Countries such as Pakistan, are on the precipice of falling into bankruptcy. No wonder India quit the Regional Comprehensive Economic Partnership (RCEP) regional trade consortium. 

The economic woes are all-pervasive and the root cause commonly follows select patterns. Individual countries have different problems. However, there is a common shared thread and select individual factors. Identifying the patterns for a specific country will help in putting up a strategy for revival. I have focused on articulating the need for a solution within broad problem areas. This blog is not exhaustive and does not go into a detailed root cause analysis or detailed solution building exercise.

Ignored Global Comparison:

In India, private debt in 2017 was 54.5 percent of the GDP and the general government debt was 70.4 percent of the GDP, total debt of about 125 of the GDP, according to the latest IMF figures. In comparison, the debt of China was 247 percent of the GDP. As of October 2018, it stands at approximately CN¥ 36 trillion (US$ 5.2 trillion), equivalent to about 47.6% of GDP. A key gauge of China’s debt has topped 300% of gross domestic product, according to the Institute of International Finance (IIF), as Beijing steps up support for the cooling economy while trying to contain financial risks. China’s total corporate, household and government debt rose to 303% of GDP in the first quarter of 2019, from 297% in the same period a year earlier, the IIF said in a report this week which highlighted rising debt levels worldwide.

In the United States, total non-financial private debt is $27 trillion and public debt is $19 trillion. More telling, since 1950, U.S. private debt has almost tripled from 55 percent of GDP to 150 percent of GDP, and most other major economies have shown a similar trend. Cumulative debt stands at 40 trillion dollars. Comparative figures from the US reveal that India is not badly hit, considering the numbers released by the Indian Government are trustworthy and credible.

Let us review select Key Performance Indices (KPI’s) of India’s financial health. Here are a few interesting figures from the State Of Indian Economy –

  • GDP growth is at a 15-year low
  • Unemployment is at a 45-year high
  • Household consumption is at a four-decade low
  • Bad loans in banks are at an all-time high
  • Growth in electricity generation is at a 15-year low

The list of highs and lows is long and distressing. But the state of the economy is worrying not because of these disturbing statistics. These are mere manifestations of a deeper underlying malaise that plagues the nation’s economy today. These figures were published in the Hindu, a very reputed and respected daily. When I share independent data from foreign outlets, those are immediately ridiculed as being ‘biased to damage the growing stature of India’.

I was talking with a building contractor friend of mine who has a meaningful business.  When prodded on his state of business, he said, everything is so dry and no new constructions are taking place. This is not my isolated discussion. Every now and then, I do probe these questions to people across the globe and India happens to be on the top. Below is a list of industry verticals that are not just sluggish but in recession (more than 2 quarters of slow down beyond certain percent points).

 

India Economic Slow Down

Industries Impacted: 

  • Manufacturing
  • Farming
  • Auto
  • Construction
  • Airlines
  • Service industry

Impact Equivalence: 

If you factor in the total percent affected, you will notice a major chunk of the population that forms the base of the pyramid, is affected because of the slowdown.

What happens now?

Well, families and business entities are at least losing 34-57% of their revenue. That’s a significant number. Spending goes down and tax collection goes down, tax at the POS (point of sales), tax from earning and tax from the business.

    1. Quantitative Easing
    2. Bad Loans or Risk prone leveraged industry
    3. Global slowdown
    4. China – A special mention
  • Quantitative Easing:

Well, let us borrow now at a cheaper rate from the Govt, or blow up what is saved in RBI (exit RBI Governors), a loan or from outside or print currency.

  • Bad Loans or Risk prone leveraged industry:

We can’t let this to catapult to a state of anarchy. We have to loan where the potential for defaults are high. Banking, Airlines, Telecom ate common examples. These were bankrupt overnight? The most common folks (shareholders) lost the most. Millions of crores of national treasure disappeared in just a fraction of time.

I disagree with “the Hindu” here. Let us understand, corruption was not just prevalent but endemic and all-pervasive. Nothing wrong, if Modi tightened the levers. At least he had guts to do that. No one including the system had shown responsible behavior and if Modi has tightened the noose, nothing wrong about it.

I will elaborate on the reasons where we are going wrong, needless and pointless to blame Modi for all the ills. Devaluation and GST came at a wrong time that confluence along with a Global slowdown, on which Modi had little control.

  • Global slowdown:

India is not alone. China, UK, Germany, Japan, the US, France, Gulf, Russia, Brazil, and many Tiger economies (remember the term for ASEAN economies used in 2000) are significantly slowed down.

  • China deserves a special mention:

China is the worst affected with 100s of ‘Ghost Cities’, flailing international trade pacts (CPEC, ASEAN and The revival of the Silk Road) and the flight of money compounded by the increasing cost of labor. It is gaining a notorious reputation of creating and exploiting poor nation’s solvency, squashing neighbors and selling obsolescence across the globe (recollect how your electrical and other goods specifically made is China have become durable and short-lasting).

India WEF

What should be done?

First and foremost, Modi has to move beyond strongman to strategist. A nation survives on vision and not just statesmanship. I have identified a few areas that will help boost productivity at the individual level, jump start the GDP and improve the health of the economy.

    1. Foundational Infrastructure
    2. Roads and Railways
    3. Satellite Cities and Telecom
    4. Innovation in Farming
    5. Revamp Agricultural Supply Chain
    6. Environment and Pollution
    7. Sewage and Containment
    8. Social Re-Engineering

India Vision and Strategy Continue reading “Boosting the State of Indian Economy”

Featured

Community Cameras Vs Home (Perimeter) Cameras

For Emerald Valley Only. Please forward to residents of Emerald Valley Only.

In general, holiday season in itself is a sufficient reason to see a spike in security related issues. Recently, we saw few security related incidences such as the cone placement or specific homes being targeted. Community cameras are definitely a great option. Several complex issues make the decision making difficult.

I talked about the top ten things that need to be considered while choosing community cameras. As against community cameras, Home (Perimeter) cameras offer an easy cost effective decision. In addition, it is available anywhere (where connectivity is available) on your smart phone. In addition to having cameras, we can supplement those with Neighborhood Watch Sign with Smart Alert. All these will act as deterrence.

Understand, this is deterrence, crime will not stop or be reduced to zero with any of the above efforts. Please visit the link to share your opinion. http://wp.me/p7XEWW-pj

Community cameras are definitely a great option. Choosing a right technology, placing the cameras at vantage points, monitoring those (in real time and historical), archiving, retrieval the saved information and policies on retrieval (viewing data) bear down the decision on proceeding with the cameras. All these activities need resources and we can either explore mobilizing our own home owners doing that or hire outside resources ($125, 000 for five years, a costly option). Thus funding also becomes a critical issue for the success of this initiative.

While we resolve the complex decisions around community cameras, I had suggested earlier using “Dummy Cameras”. The design of those dummy cameras can be made to retrofit, if we decide to proceed with permanent community cameras, once we choose a permanent option. Dummy cameras backed up with signs such as “Neighborhood Watch with Smart Phone Alert” can dissuade or discourage many. Thus, reactivating Neighborhood watch and repainting those signs indicating Neighborhood Watch with Smart Phone Alert will provide an interim workable option.

Below, I have reactivated the polls to collect the community opinion.  Please forward this to anyone within the community. These polls will end on Dec 26, 2016. Please visit the link on http://wp.me/p7XEWW-pj. I have called out the Top Ten Things to consider while placing the community cameras.

Several factors are important while choosing and placing the cameras. Eg. Fixed focal length lenses are available in various fields of views: wide, medium, and narrow. A lens that provides a “normal” focal length creates a picture that approximates the field of view of the human eye. A wide-angle lens has a short focal length, and a telephoto lens has a long focal length.

Top Ten Things to Consider while Placing Community Cameras

  1. Location of the cameras – unobstructed view, redundancy (if one fails or obstructed by a vehicle, alternate place for capturing). Away from Vandalism. Mounting Electric poles or homes where cameras can be
  2. Types of cameras (depth of field) – narrow angle, wide angle regular, pan tilt zoom (PTZ) etc. Wide angle is required at the entrance and exit, where as a narrow angle will be required while focusing on the alley or narrow street. Zooming will help if there is active monitoring. Tilt and pan will serve a similar purpose.
  3. Frame per second – remember, intruders will be very fast and agile in completing their tasks. Higher number of frames per second helps in gathering precise information
  4. Night vision enabled cameras are a must obviously since thefts are like to occur while it is dark.
  5. Cloud storage and safety of the data is critical. While dealing with a cloud solution, you may want to explore if that is from the manufacturer or service provider.
  6. Power option – solar powered are best preferred.
  7. Integrating all the cameras into single dashboard is not a difficulty thing but you need folks with sound knowledge in networking.
  8. Monitoring (do we want real time monitoring?). Who will be responsible for retrieving older information, how long do we save that information etc.)
  9. Policies and Access to Saved data needs an adequate understanding from the users. This is one key aspect that will cause a lot less heartburn if resolved early on.
  10. CCTV and cabling

Don’t forget to account for – 

  1. Installation cost (not the purchase cost)
  2. Maintenance (include services, repair or replacement)

Overall, you need Governance on all these aspects. A group of dedicated folks with experience and or understanding on the different aspects need to handle all issues related with cameras. I know, you might have just thought that I made it so difficult. However, it is easy to install and very difficult to maintain unless you have given an adequate thought to all these aspects.

How about Residential Cameras?

Home perimeter cameras are still a good option. Cheaper, no hassle decision, and monitoring under home owners control (on the Smart Phone). In addition, they provide granular information right until where the incidence is happening (in this case your home). My personal experience has been exceedingly good since the time of placing (Perimeter) Home Cameras. Dummy Cameras on my farm have provided me a lot of safety too.

Use the same 10 principles mentioned above while installing home perimeter cameras.

To conclude  

Multiple layers of security are required to secure our community. Each has its place, advantages and disadvantages. Also, just in case one fails, we have other layers of security. While a decision of installing community cameras is not an easy one, community should explore interim options, such as dummy camera, that are easy to deploy.

Not sure why we wait in closing decisions on issues that matter us universally? Do you think you don’t need this because you will never be affected? Are we waiting for someone to take an initiative? Are we opposed to installing cameras? Simply voice your opinion. It stays anonymous.

Please share your opinion –

To see additional opinion from community members on security related issues or for additional links on below topics, visit documents or links on –

http://wp.me/p7XEWW-8E

The blog mentioned above offers hyperlinks to topics or documents addressing concerns on – 

  1. GUIDELINES FOR PUBLIC VIDEO SURVEILLANCE: A guide to protecting communities and preserving civil liberties
  2. An example of Camera Policies from University of Wisconsin at Green Bay
  3. Code of practice: A guide to the 12 principles (This does not apply to US scenario but it offers good understanding of issues to consider)
  4. Camera Types from Brick House Security (Offers an understanding of different types of cameras)
  5. Principles of Design for Operational Risk Reduction

 

 

Am I Culpable for Spreading Virus?

This is a classic example of invincibility and complacency – that nothing will happen to me even while the entire world is suffering from COVID.

Passengers went on a cruise while COVID was raging, presuming that COVID won’t infect their isolation on the ship (in deep water!) never realizing that asymptomatics are the core carrier rather than those who are actively infected.

Exactly this is what happens around us. Yesterday, I was talking with a friend and I realized, he was not using a mask despite the incidence being very high in their state.

That’s pathetic, I understand coronavirus is not seen and leave behind a trail of fragrance but understand, every time an asymptomatic exhales or sneezes, they blow approximately 54 million copies of the virus in the air. It is now known that these copies stay for at least 3-6 hours in the air. That air may drift in your direction and not having a mask while exposed to the potentially infectious airborne virus is culpable negligence, especially knowing that it may make you another asymptomatic carrier.

This pandemic is replete with examples where the asymptomatic have infected the gullible and innocent unexposed. It is the later who has taken the brunt from SARS CoV2.

Shashank Heda, MD
Dallas, Texas, US

Coronavirus: Dozens test positive for Covid-19 on Norwegian cruise ship
https://www.bbc.co.uk/news/world-europe-53636854

The ‘Good and Not So Good’ of COVID-19

While COVID-19 is taking a huge toll across the globe, humanity is displaying a polar reaction – a not so invincible risk taking attitude and a scared, vulnerability. The answer lies in between these two polar extremes. A balanced approach will help to prevent COVID at the individual and family level, which will eventually also be reflected as a social index for measuring our progress while preventing SARS CoV2 and treating COVID-19 patients.

I discussed the ‘good and not so good’ aspects associated with the prevention of COVID-19 and our own vulnerabilities. The initial battle with COVID is in our mind, where we either think we are vulnerable or invincible.

Let us visit the “Not So Good” part early. 

The spike of COVID-19 is huge across the sunbelt of the US. Several southern states are massively infected due to the COVID-19. The virus is seeing a massive resurgence in the UK, EU, and Australia. It is still in its ascendancy in India, Pakistan, Sri Lanka, and several southeast Asian countries. The Middle East is just catching the fever. Brazil and Latin America (currently in their winter) are seeing a heavy toll. 

While COVID-19 is still raging across the globe, humanity is displaying a polar reaction. On one side, we feel strong and ready to take risk, on the other side we are scared and vulnerable. Can we balance our approach and fight this virus? The answer is a definite yes. How do we do that?
The Good and Not so Good of COVID-19

Intrinsic Vulnerabilities are in our mind

You may be thinking, our body is vulnerable and weak and so we catch the infection. While, most amongst us are following precautions., precautions are not enough. We see at least two major vulnerabilities despite following precautions – 

  1. Strictly following precautions and giving up occasionally
  2. Not understanding the innate immunity and how that helps

Let us talk about the occasional vulnerability that we create and expose. 

Restless Inside Home

Several amongst you are restless inside the confines of your home. You are frustrated, bored and some are just angry enough to throw those precautions to disdain. You want to step outside, you are thinking the risk is not what it sounds like, you may be thinking you are young and have a very low probability of acquiring the viral infection. You may be thinking some socialization is ok, more is not good, so let us go for a walk, maybe pub, may have a blast with a limited circle of friends, maybe shopping, etc. etc. 

Are you Alone? 

Think like this – 

1. If the risk is low, why do we see the resurgence or ascendancy of COVID across the globe? 

2. If you are young, have no risk factors, why are young people succumbing to illness?

3. If you say, your ethnicity provides protection? Can you check the mortality data for those exposed within your ethnicity? 

You may be thinking little social interactions are good (walks, pubs, dinners, outings, little shopping, little business, etc.). It is exactly these vulnerabilities that are perpetuating the spread of viruses. 

Do you know?

For every symptomatic patient, we have anywhere from 5 to 10 asymptomatic patients. Are you sure you are interacting with someone asymptomatic (carrier) and have no virus? I have seen several cases where the person stepping out got the asymptomatic carrier, infected those innocent parents/kids/spouse/family members and the later died. Consider these scenarios

  1. I don’t think you can live with the guilt of being responsible for the death of near or dear one. 
  2. Presuming you will survive, what is the guarantee that your organs will not be compromised for a long time? 
  3. Let us presume, you die from illness, have you thought of the implications of your loss on those surviving? Please read surviving with COVID stories and make your choice. 

How do you protect yourself?

CDC has given guidelines for protecting yourself. Every Government has made the best attempts in guiding their citizen from COVID-19. Following those is the utmost while undertaking any activities for your local area. 

Activate your Internal Resilience 

First and foremost, please decrease your exposure and risk. However, boosting your immune system with Yoga, Physical Activities, Sleep, Balanced Diet (and avoid refined diet), and meditation are great ways of doing so. I also saw some interesting read on Mayo Clinics. However, several educational institutions are providing a wealth of knowledge on those. However, reaching out to your doctor at the first instance of suspicion is best. 

The Good News

In its July 7, 2020 issue, Nature Immunology carried an interesting article on why the disease burden varies differently across regions. Simultaneously, the same paper has speculated that previous infection from Common Cold Coronaviruses (CCC) exposure also provides protection, against SARS CoV2. Excerpts from the article below

‘Pre-existing T cell immunity is related to CCC exposure, it will become important to better understand the patterns of CCC exposure in space and time. It is well established that the four main CCCs are cyclical in their prevalence, following multiyear cycles, which can differ across geographical locations. This leads to the speculative hypothesis that differences in CCC geo-distribution might correlate with the burden of COVID-19 disease severity. Furthermore, highly speculative hypotheses related to pre-existing memory T cells can be proposed regarding COVID-19 and age. Children are less susceptible to COVID-19 clinical symptoms. Older people are much more susceptible to fatal COVID-19. The reasons for both are unclear’. 

If these speculations are proven, it can rightly be said that T Cells have a lasting memory towards previous CCC that may be reactivated during a SARS CoV2 infection and offer protection. 

https://www.nature.com/articles/s41577-020-0389-z

Shashank Heda,

Dallas, Texas

(On behalf of CovidRxExchange) 

a nonprofit initiative to help global doctors fight Covid-19

Visit – https://www.covid-19rxexchange.org/)

A dubious distinction

The US has reached a dubious distinction of being a global leader in having 4 million cases of Coronavirus. What leads to this grim scenario? Often, that outside wonder where is the vulnerability. I shared a different perspective on the factors contributing to this grim scenario. In my opinion, there are several factors that contribute to these dismal figures. Understanding the failure is as important as understanding the success, it is through failures that we get a glimpse of success as it offers us an understanding of modeling success and our collective behavior. In this article, I have made attempts to capture aspects across major democracies that offer an insight into success and failure.

The US – then 4 million coronavirus cases. The US is the global leader in Covid-19 cases, followed by Brazil, India, Russia, and South Africa. The statistics run like this –

99 days to reach 1 million
43 days to reach 2 million
28 days to reach 3 million
15 days to reach 4 million
… days to reach 5 million

https://ourworldindata.org/coronavirus-data?country=USA~BRA~IND~RUS~GBR~OWID_WRL

A global leader again (pun intended), how could a country reach such epic proportions of the disease in just 180 days. At least 143,820 people have died across the country. Where is the indiscretion? Is it that the population is vulnerable? Or are we following flawed models of prevention?

Let me cite an example – my HOA asked me to fix the turf, stating it is an essential service. Of course, I responded saying why it is not but this is a reflection of a flawed model being followed.

A confusion between essential and non-essential is the major factor. Another aspect that is scientific activism by gullible people called ‘Corona Mixer’. It is akin to a flawed model of Herd Immunity followed in the UK, Sweden, and few other countries, where COVID-19 eventually exploded.

Third, fatigue from indoor has wrongly motivated several families to stride outside. Of course, a gullible common man cannot see the 54 million viruses that were just sprayed by an unexpected asymptomatic person in the vicinity that followed that infects other innocent bystanders as it drifts along the path of air currents.

There are more factors to the proliferation of the disease. Another complex issue is Political liberalism and assertion for a cause. Subversion or a feeling of being subverted is causing people to rebel and aggregate. Incorrect policies and guidance by WHO and other policy-making bodies is another contributing aspect factor.

Policies – a bedrock for containment: Policies offer a solid fabric for control and on the converse is equally true that not having consistent machinery to execute policies is an equal deterrent. I will shy to quote an example from a major city from central India where a breakdown of communication amongst the policy executioners resulted in a flare-up of COVID across the town. Remember, if only the infected (symptomatic and asymptomatic) can strictly isolate, we can contain the virus.

Indore a success story

We have several success stories from around the globe but visit CovidRxExchange to learn about, Indore – A Success Story. You will see how a metropolitan city controlled the disease at the outset with a well-executed policy and a diligent team of doctors.

Can we change this? Possibly that’s the Midas touch that would delay and possibly deter further infection.

Shashank Heda, MD
Dallas, Texas

References:

https://ourworldindata.org/coronavirus-data?country=USA~BRA~IND~RUS~GBR~OWID_WRL

https://www.ncbi.nlm.nih.gov/research/coronavirus/publication/32691016

R(0) & The Real Numbers

The daily cases of positive SARS-CoV2 are rising in several states. Newspapers and Govt. channels are providing the total positive cases detected daily. However, a visibility on the total burden of positive cases is not available despite knowing the daily stats. Often, it is erroneously thought that the cumulative numbers are less.

In this blog, I have talked about the incidence and prevalence of the persons affected that are shedding the viruses in the community, both from the symptomatic and asymptomatic perspective. The average number a symptomatic patient sheds virus and the average number an asymptomatic person sheds the virus is based on the the referenced scientific data. The details are mentioned in this blog.

This blog provides us a perspective on the cumulative cases within a community as well as how long should we continue lock down amidst the airborne nature of the virus.

Let me explain the concept of incidence and prevalence.

Incidence is the new cases occurring in that period, whereas prevalence is the cumulative cases existing during that period. If I presume the incidence at the time of collection of the swab is 10,000, and the asymptomatic is 5x to 10x (let us call it A), the total burden of positive cases is in that proportion.

If we are to presume the disease persists for 14 -21 days in its mild form, then the prevalence now is 14x-21x the multiple of A. If I go by some researchers, the asymptomatic shed the virus for 21-28 days.

That’s the total burden of test-positive cases.

Airborne precautions are likely to be scaled up on the risk stratification. All those risk color charts floating around are likely unreliable for this simple reason. To make it simple, I will just make two categories –

Essential
Non-essential

Non-essential are all those without which we can survive.

You may naturally ask, until when should we live like this? It’s not too long, vaccines and drugs are on the horizon. Also, though the virus is still aggressive, it will likely become less aggressive in the future. So, let’s wait before taking an unrequired risk.

Shashank Heda
Dallas, Texas

Shades of Gray

Interrelated phenomenon Shades of Gray – Gene Manipulation to establish hegemony, Drug Hoarding and Vaccine Nationalism,

It is understandable, the US started vaccine and drug hoarding, contrary to the principles of humanitarian values and ethics. Hegemony and lack of transparency from China and other power are adding towards a heady mix. This initiated a sense of self.

However, scientific pursuit falls within the realms of humanitarian traits, it is not nation-specific, or unique to any ethnicity, and definitely not the fiefdom or expertise of any ideology or religion.

Having said this, despite the attitude of select countries, we should keep humanity and altruism as our highest pursuits and avoid getting muddled in the politics of nationalism, ethnicity, ideology, or religion.

Every country should attempt in advancing science, however, we should not succumb to vaccine nation, drug hoarding, or manipulating the genome of the wild viruses and or bacteria for usurping our hegemony to advance our nationalistic endeavors. We all know, Science is a double-edged sword, used rightly will lead to evolution, and unlikely use to destruction.

Dr. Shashank Heda,
Dallas, Texas

Stay Safe! It’s a cliche!

The tidal second wave of Coronavirus is surging across the globe. What went wrong? Was easing the lockdown a wrong decision? or was it our inadequacy to understand the virus behavior? Can we understand what went wrong? We each define the microcosm of the society and we contribute towards the spread via our Social Bubble or contain the Spread with our responsible behavior.

I have captured all the risks factors and how to fix our own behavior during this tidal surge of COVID wave.

Stay safe has become a cliche, like Good morning, bye etc.

Friends, this week has been extremely bothersome as the second wave has been not just huge, not just a tidal wave but a seismic wave, and a tsunami that may overwhelm our healthcare system. Not just in Texas alone, it is across the US mainland, the UK, the EU, China, India, Brazil, Mexico, etc. It is extremely scary.

What went wrong?

First – let us understand some principles of transmission of the virus. Second, let us understand our fallacies. Next, let us understand our social dynamics.

A) Virus Transmission –

A virus multiplies in 100,000 copies in one single day. Almost, one bout of coughing produces 54 million copies, that fly as aerosol and also settle as fomites. Being a tough virus, it survives in the air for almost 3 -5 hours, depending upon the ambient conditions. The warm and humid environment makes it hang around longer. It drifts with the air current or stays suspended without a drifting, with no wind current. The peak is 14 days, thereafter the virus gets neutralized in the patient.

Symptomatic patients are not the only bug spreaders, for every symptomatic patient, we have 10 asymptomatic patients who are spreading the virus. However, for asymptomatic patients, the virus cycle continues for almost 28 days. Unfortunately for us and fortunately for the virus, it is colorless and invisible and since it is invisible, we feel pseudo confidence that we are invincible.

B) Our fallacies –

We presume the virus is not there. That and given our boredom of staying inside makes us extremely prone to catching the infection. We are frustrated staying secluded, within the confines of our four walls. But you are not alone, almost over two billion people on this planet earth are secluded and claustrophobic within the confines of their home. We all know social distancing but I see several families taking a stroll without masks, not knowing that they may be inhaling the virus.

Somewhere, we presume, it is a disease of the elderly. I have seen several case reports of a death within the young and healthy. I have seen case reports of kids suffering immensely from COVID. I have seen elderly parents escaping death. This all points towards one thing – that Science has not yet definitely identified risk factors for mortality and morbidity. Thus the virus behavior remains elusive and erratic. You may get the bug, harbor it and unknowingly, you become a super spreader. I see school kids interacting with each other. How can we ensure that those they are playing with have no disease (asymptomatic carrier)?

Social Bubble – Exactly, this small social network connects us with other tiny bubbles, and this is becoming the route of spread. New Zealand is the first country to realize this and they broke the vicious cycle and almost eradicated the virus. They will, however, get reinjected, once they start air travel though.

Work Bubble – We think, we are acutely dependent on running our family for a livelihood, not realizing that those who are working can become asymptomatic carriers and transmit to vulnerable parents staying with us. Are we so careless? (@Dr. Shashank Heda, for COVIDRxExchange.Org). If we have to essentially step outside for a living, let us live under a different roof, not with those family members who are vulnerable.

What Do We Do?

  1. Strict Social Distancing is not enough, we will be inhaling the bug via several routes.
  2. You all need to suspend all strolls, shopping, and other errands. Let us minimize exposure as much as we can. Can we buy online?
  3. Fomite transmission is deprecated. That means fomites do not pose as much risk as was considered previously. Please visit CDC for the guidance.

Summary: If you have let your guards down, a “new high probability” risk factor that will determine your chance of getting the infection. You can make your choices.

Coronavirus – A Weekly Roundup

Friends, ‘First a Happy Friday’. Let us round up the events of this week (June 15, 2020) as we have seen exciting and not so exciting stories for this week. Let us demystify those one after the other – Dexamethasone, Testing, Huge Second wave, Unscientific Americans, declining Antibody titer.

Dexamethasone

This steroid is suddenly touted as a panacea for mankind to protect its herd from Coronavirus. Let me say, Dexamethasone is used only for seriously ill patients. The drug has been shown to reduce the mortality in severely ill COVID patients those on a ventilator. So, make a note – It is for severely ill patients on a ventilator. It is not for prevention or cure of mild or moderate disease, and of course not for asymptomatic carriers.

How does this help me as a common man? This is not for prevention or cure of the mild to moderate disease. Other drugs and vaccines are in the pipeline.

Testing

The percentage of positive tests is rising across the Sunbelt, Arizona has 15.9%, Texas 7.9%, and Florida is high. Rising temperature and spreading Corona has dispelled a myth, that it is associated with Cold. Beyond numbers, an average of 5% – 8% positive are considered within the normal range for a pandemic (ideal is 0%), however, when the numbers rise above 8% it is time for a lockdown. However, let us understand, if the probability of positivity is 8% that means you have a 92% probability of negative test results, or in other words, 1 in 10 patients will test positive with a similar spectrum of symptoms.

Let us look at these 1 out of 10 positive cases. The probability of mild disease (given you have no risk factors) is 80%, another 15% have a probability of moderate disease and 5% have a grave outcome. It is surprising that Corona takes a toll on the young and healthy, and spares often the elderly recover from the disease. Another aspect is the residual scarring after recovery. Both these aspects mandate taking deferring unrequired risk.

How does this help me as a common man? The symptoms between Coronavirus and other respiratory virus overlap a lot. It is wise to get tested and be confirmed negative, rather than deny it and get delayed help.

What is an unrequired risk?

I see several kids interacting in my neighborhood, adults taking a stroll, and few doing their business without masks or adequate protection protocol after presumed exposure. Of course, Coronavirus is not a cloud. So if you have an asymptomatic person taking a stroll in the 2-3 hours window preceding your stroll (let us add no wind current during this time), he has left behind a cloud of virus-laden aerosol which you will naturally inhale. I presume you recollect how tightly the S protein binds to the ACE2 receptors of the human cells. (@ COVIDRxExChange.Org; Visit http://www.covidrxexchange.org).

How does this help me as a common man? It is best to avoid walking in a public place until the second wave has waned.

The Second Wave

We predicted it right before Memorial Day that a second wave is in offing. What I failed to predict was the Floyd Protests and the huge second wave due to claustrophobia. This wave is huge and I will not be surprised to see another lockdown. However, the economy has exhausted its appetite for another lockdown, and only when the hospital beds are exhausted, that they will say, “Flatten the Curve” and impose another lockdown. Let us not worry about the schools reopening in fall. Fall is too long, let us follow R0 (naught).

How does this help me as a common man? 99.99% is not enough; do not let your guards down. Follow precautions as stringently as possible.

Unscientific Americans –

Dr. Fauci is right when he said, Americans are unscientific. Look at the malls, the beaches, and the pool parties. What is the point in having a six feet separation?

How does this help me as a common man? Follow precautions as stringently as possible. Try to understand the science behind the cause and effect. Model your life according to the scientific principles. I would visit CDC guidelines and follow those as strictly as possible.

Antibody Titer

Reports have started emanating that the antibody titers wane after 2-3 months. It does sound scary as the protection from the previous disease (in the exposed and affected) lasts only for 3 months. Well, I want to assure you, cross-reacting antibodies and memory persist and even if re-exposure happens, this memory gets activated and will build a faster immune response. This is how all vaccines work.

How does this help me as a common man? I won’t worry if I read news about waning titer after 2-3 months. My small pox childhood vaccination still offers me a lifelong protection.

Quiz time –

If you inhale one virus, how many daughter coronaviruses are produced in 24 hours?

Shashank Heda, Dallas, Texas (June 19, 2020)

COVID & Spanish Flu – Comparison and Contrast

102 Not out – Approximately 102 years back, the world was ravaged by Spanish Flu (a misnomer) and today, we are reeling under COVID-19. Both pandemics caused significant pandemonium, and share a common pattern. While it is understandable to see an intermittent new ‘human – microbe’ interaction, going awry, the current pandemic has exposed our fault lines and our preparedness after 102 years. It is not about microbes and our immunity, it is a testimony of our (un)evolved human journey or rather stagnation of evolution in the last 102 years.

102 Not Out, provides a succinct comparison and contrast between the Spanish Flu and COVID-19 and a poignant story of our collective failure.

Background

1918-19 – That period must be the one coinciding with your grandparents or great parent’s birth. So, memories are only through archival records. The global toll was almost 50-100 million, whereas the US lost some 685000 people (a very high percentage for the population at that time). India had 5% mortality with over 12 million succumbing to Spanish Flu.

Spanish Flu – What is that?

Is it truly Spanish flu? It started in France and England. However, they both were at war and wanted to keep this covered. However, Spain being neutral, and news being public, it was reported transparently. It is a misnomer to call it Spanish flu. That is derisive, as Spain was neutral during WW I. It was World War I and soldiers were living in overcrowded barracks. It started in Etaples, France in 1916. It will similarly be wrong to construe that it was an element of French warfare because a similar disease was also observed in 1917 at Aldershot, England. Then too, it was commonly thought to have jumped the animal-human borders as pigs and poultry were a mainstay at these hospitals.

It never occurred to them that they would take the Influenza bug along with them while traveling back home. A disease that once was restricted to specific geography quickly became ubiquitous and spread out indiscriminately. As John Barry said, in New York Times, “None alone provides great protection, but the hope was that if most people followed most of the advice most of the time, the interventions could significantly reduce the spread of the disease, or “flatten the curve,” a phrase now all too familiar. This may sound simple, but it is not. As with a diet, people know what to eat but often stray; here straying can kill”.

3D_Influenza_transparent_key_pieslice_med

(Picture Credit – CDC illustration on influenza virus. Influenza A viruses are classified by subtypes based on the properties of their hemagglutinin (H) and neuraminidase (N) surface proteins. There are 18 different HA subtypes and 11 different NA subtypes. Subtypes are named by combining the H and N numbers – e.g., A(H1N1), A(H3N2). Click on the image to enlarge the picture).

It almost engulfed an entire then connected globe. However, the definition of connectedness, which was ignored then and which is ignored now too, is common to both the Spanish Flu and COVID-19. An estimated 500 million people worldwide were affected. It was a rudimentary period in the evolution of medicine and of course, there were no vaccines or medicines to treat the patients. The findings were, as usual, generally, healthy young adults succumbed to the illness, contrary to most diseases that took the life of the young and old. Today, we call this onslaught of infection against those with a mature immune system as Cytokine Storm. Then, we only knew it killed the young. Then too, people used hand washing, isolation, masks, avoiding public places, and quarantining those ill/suspected ill. It ravaged the economy and disrupted public life, basic civic services like garbage clean up, and postal delivery government services etc. were compromised. There was no one to cremate dead bodies; garbage was flying astray across the streets, no one to light neither lamp posts nor sufficient people to deliver the mail. City offices started digging mass graves, closed schools, public places including theaters. The truth was not transparent, trust in authorities deprecated. Then too, there was a lurking fear that ““civilization could easily disappear from the face of the earth.” Reopening then was marked by a rebound in cases.

Rebound after Reopening

Spanish Flu Rebound

In its intense and acute form, the malady lasted for almost 15 months, from the spring of 1918 to the summer of 1919. It is said that this pandemic Flu almost killed 50-100 million people. Today, we call that Influenza A or H1N1 flu. H1N1 kept lingering, again due to mutations, for 38 years until it was controlled with specific therapies.

Antigenic Shift versus Antigenic Drift

Influenza A and B, each has 8 genes and a variation keeps happening to make a combination each year. As investigations reveal, the 1918 pandemic started with an H1N1 strain, that kept mutating. At this moment, it is wise to understand the meaning of H and N, H stands for those proteins which are required to latch on the cell (inside) and release themselves (N proteins) when mature to infect other cells. This protein structure keeps changing slightly, called antigenic drift. Sometimes, the virus mutates significantly with major changes in the structure of the H and N proteins, called an Antigenic shift.

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Fast Forward 2019-20 – Comparison and Contrast

It is commonly accepted believe that SARS CoV2 jumped the animal-human barrier. It too spread out from densely populated places. Like COVID-19, it took the world by surprise. No one anticipated that the global burden of death would be over 250, 000 in just 4 months. Then, there was no medicine and here again, we have no specific remedy. The mechanism of death was the same, cytokine storm prevailed then and it is reigning now. It took away the young healthy adults then, however, it is incapacitating for those young adults now, though the mortality is very high in the elderly. Then too, we used masks, isolation, and barrier protection, which we see as the mainstay of stopping the virus within the communities. We call it social distancing, back then, they called it crowding control.

What have we learned?

We see a commonality in the pattern. The biological behavior of the bugs is not changeable. The human response was almost the same. We respond exactly the same way how we responded then. We distanced from each other, we realized, it was spreading through our breath and mouth, so we used masks in 1918 and again, we are using masks. Is there anything wrong with this?

Quotable quotes from Christopher Nichols, Associate Professor of History at Oregon State University –

“The questions they asked then are the questions being asked now,”

“And while it’s very rare that history provides a simple straightforward lesson for the present, this is one of those instances. The Spanish flu tells us that social distancing works. And it works best if we act early, act fast and stick together — and base our decisions not on social or economic concerns, but on science and data and facts.”

References:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997248/
https://www.nytimes.com/2020/03/17/opinion/coronavirus-1918-spanish-flu.html
https://www.webmd.com/lung/news/20200420/four-lessons-from-the-1918-spanish-flu-pandemic#4
https://www.cdc.gov/flu/about/viruses/types.htm
https://www.cdc.gov/flu/about/viruses/change.htm

 

https://interactives.nejm.org/iv/playlist/index.html?media_id=siCcYW3U&pcs=sidebar

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997248/https://www.nytimes.com/2020/03/17/opinion/coronavirus-1918-spanish-flu.htmlhttps://www.webmd.com/lung/news/20200420/four-lessons-from-the-1918-spanish-flu-pandemic#4https://www.cdc.gov/flu/about/viruses/types.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997248/https://www.nytimes.com/2020/03/17/opinion/coronavirus-1918-spanish-flu.htmlhttps://www.webmd.com/lung/news/20200420/four-lessons-from-the-1918-spanish-flu-pandemic#4https://www.cdc.gov/flu/about/viruses/types.htm

Stopping the Pandemonium from Pandemic

To me, this situation is like a war that is imposed on a country. You don’t want to lose lives whereas, you still have to fight a war. It’s a dilemma, difficult to discern. None of this was anticipated in advance, or rather, most Govt’s. were not aware of these.

Even doctors make a decision based on benefits versus cost. Most planners struggle with this dilemma and much of their decision-making nodes are based on this.

Losing life is not the option but when you factor in those folks who have run out of money and be in their shoes, we realize the hurt and the pathos of daily living. Politicians and Policy makers alike face this challenge. If they ignore, it will end up with rioting, anarchy and add further to the pandemonium created by this pandemic.

Tribal Instinct & COVID

This is the story of two tribes who want to seclude themselves to prevent coronavirus. Irrespective of whether the strategy works, State cannot impose its will on the people. It is interesting to know that the Cheyenne River Sioux Tribe had rejected an ultimatum by South Dakota’s governor to remove checkpoints on state highways within tribal reservations or risk legal action. According the head of the Tribe, the checkpoints are built to save life, not faces.

‘Individual Identity to Protect’

This becomes important for two reasons –

1) The Tribes have a right to their reservations. In an informal sense, they are a country on their own and the will of the state cannot be imposed unilaterally upon the tribal reservations.

2) Proponents of Herd Immunity insists that isolation will deprive the development of resistance to the virus. Isolation, Social Distancing and ‘Shelter-in-Place’, are social mechanism contrary to herd immunity. It is worth noting that absence of herd immunity makes the population vulnerable to further waves of COVID. Whereas, the detractors persists saying that the innate immune arm serves as the logical arm to counter new infections.

I agree, one of the strategies for countering bugs is to make them commensals and coexisting with them. However, this cannot be enforced. When the state decides to impose its will on the minority, it infringes not just on their rights but their existence.

Excerpts from National Geography

Native Americans are especially vulnerable to COVID-19 due to underlying health issues such as diabetes and heart disease, as well as crowded multigenerational homes. On reservations, where roughly half of Native Americans live, not everyone has indoor plumbing or electricity, making it difficult to follow the guidelines to wash hands regularly in hot water. As a result, Navajo Nation, the largest reservation in the United States, has an infection rate nearly as high as that of New York and New Jersey. As of May 11 there have been 102 confirmed deaths.

‘Blood memory’

The indigenous Native Americans from several states have truly bloody memory from the past panemics. Smalpox is an example, during which their tribes lost significant number of natives. Some elderly haven’t yet come to terms with those deaths yet.

When you have social structure that is so intricate, interrelated and interwoven, it is necessary to create checkpoints to isolate. 

Contagion and Contact

History has ample examples of secluded cultures, ethnicities, and congregations being wiped out after interaction with those having an advantage of a wider swath of commensals. If we understand history, we understand the reason for this tribal instinct. If we lose the context of history, an unilaterally impose our will of integration, we will lose them again.

The entire civilization in the Americas was lost to guns and bugs. The Incas, the Mayas, Aztec, and the other smaller tribes. We know how the Spanish conquistador bought plague and other diseases from the then most filthy continent on the face of the earth. Another example is the now reigning tribes in the Amazon. And the most notable are the tribes from the Andaman, an archipelago in the Indian Ocean.

Is it our tribal instinct to expose the entire population to SARS CoV2 better or is there tribal instinct better in safeguarding their cluster and ethnicity?

Shashank Heda,
Dallas, Texas

https://www.nationalgeographic.com/history/2020/05/indigenous-spiritual-leaders-offer-wisdom-during-the-pandemic/

South Dakota governor tells Sioux tribes they have 48 hours to remove Covid-19 checkpoints
https://www.cnn.com/2020/05/09/us/south-dakota-sioux-tribes/index.html

New Hypothesis for Cause of Epidemic among Native Americans, New England, 1616–1619 ; Emerg Infect Dis. 2010 Feb; 16(2): 281–286; John S. Marrcorand John T. Cathey;  doi: 10.3201/eid1602.090276; PMCID: PMC2957993; PMID: 20113559

https://www.nativewellness.com/

Indian mortality in northwestern

2011_vol_2 SAARC Cultures

Prehistoric and Historic Interface

depopulation_of_native_america