Community Work – mymilieu.org

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.

Shaking the Citadel of Democracy

We realized the pain of the threat to democracy on Jan 6, 2021, when the Capitol was under attack. Fortunately, the DC law enforcement thwarted an attack on the elected representatives and the Capitol. However, it would have been a tragic accident and a watershed event in the history of the US democracy and an entire experiment of global democracy if the US would have come under authoritarian rule. Fortunately, the US was saved, but Myanmar is an example of where it happened.

In the May 2019 issue of the Diplomat, Jieun Puin warned about China’s increasing influence in Myanmar. Like China Pakistan Economic Corridor, the China Myanmar Economic Corridor (CMEC) has taken a toll on the Myanmar Democracy. It is unwise to exclusively blame the military junta for aborting a democratic election for the coup.

When democracies are trampled and their citadels attacked, it takes away the right of the common-men to decide her/his fate. Democracy offers the common man an ability to coexist with pleural views; an authoritarian or totalitarian system takes away that very right that we all are born with; by no means democracy is a perfect system or a panacea of hope. However, in such regimes, the common man is deprived of influencing his/her collective choices and future.

Word count 992; reading time 5-6 minutes. Why read this article? To understand the fragile dynamics on which democracies thrive. The torment and the anguish of the people of Myanmar are obvious.

Zoltan Barany in the 2015 issue of the Diplomat, had correctly voiced, that Suu Kyi’s NLD government challenges of managing its relationship with the Military, its inexperience with bureaucracy, the deep seated corruption and the menace from China. Almost a week now, the democratically elected government of Aung Sang Suu Kyi’s (pronounced chi) NLD was dismissed. Its leaders rounded up and bolted into confinement. Mother Suu Kyi herself is being investigated for having ten microphones, a high crime and treason?

Burmese Saga is all interesting.
We all know Aung Dang Suu Kyi spent 15 years in solitary confinement under house arrest. A daughter of a martyred military general, she was barred from holding high office since she married a British national. Until the Rohingya crisis ensnarled Myanmar, Suu Kyi was considered an apostle of human rights and rightly bestowed the noble prize.

Buddhist versus Muslim
It is worth lamenting that none of the 56 IOC Muslim countries took the cause of the Rohingya minorities. The Vatican was the first to voice the humanitarian crisis, not considering his faith. It is not news since the refugee crisis that emerged after ISIS in Sudan, and its hinterland consisting of Iraq and neighboring countries broke loose. As though Europe was their natural destination, none of the 56 Muslim countries offered asylum to these refugees. Turkey accepted few but acted more as a conduit and transition hub for these refugees to Europe. Of course, it demanded financial support for taking care of these refugees. At that moment, I felt as though the refugees were abandoned children of Europe that they had to take care of.

How are Buddhist connected to Rohingya?
In a Buddhist majority nation, the infiltration by Muslims from Rakhine province was seen as infiltration. Suspicions of radical activities initiated a spate of violence. Ideally, in my opinion, it was ethnic strife that was colored with religion. Irrespective, Aung Sang Suu Kyi defended its military action at the Hague, which eroded her credibility.

In Myanmar, the Military Junta, also called Tatmadaw, are deeply institutionalized and legitimized through statutes. Any change to the statute needs a 75% vote from the combined elected house. However, the Military has 25% representation on the constitutional bodies (for enacting the law). Simply speaking, it is farcical to think of Myanmar as a democracy. Democracy in Myanmar, like that in Pakistan, is a facade for the Military. Those who are conversant with the Pakistani model of military democracy need no priming on this subject, except that it does not have a gnawing hatred towards India. Like in Pakistan, the Myanmar Military has built deep inroads into various facets of the business. The Junta directly owns State-owned financial institutions.

Mother – More than an apostle of democracy
Suu Kyi is more a mother than just a hope for democracy. While her husband was on death bed, she wanted to visit him in the UK. The Junta gave her a simple option, a one-way ticket to the UK, and renounced her citizenship. She preferred to stay behind for her people, understandably a tough decision.

The Chinese Angle
Under Aung San Suu Kyi, the annual trade volume between China and Myanmar, declined 22.9% to $4.67 billion. Also, Kyaukpyu development in southern Rakhine state, which the Chinese planned as a strategic port with access to the Indian Ocean stalled under Suu Kyi. In recent times, under Suu Kyi, the national debt towards China decreased by 26%. Financial and economic engagement with the west increased significantly. This was a definite threat to the Chinese Belt and Road initiative. At least two ports, one facing the Bay of Bengal (with direct sight to Chennai, Vaizac, and Kolkatta) and the other Yangon, facing the Indian Ocean, are critical for China. Both these ports and the BRI were under direct threat from a democratically ruled NLD government. Destabilization is the cornerstone of authoritarianism, and the Chinese are adept at sowing the seeds of such destabilization. It is equally true that the instability in the Kachin and the Shan State adjacent to the China border, drove several rifuges to the Yunnan province of China.

Aijas Ariffin, https://theaseanpost.com/article/myanmar-crisis-getting-out-hand

Min Aung Hlaing – A pent up lifetime hope
Unlike democratically elected governments, authoritarian governments are ruled by rulers with a long half-life. Putin, Xi, Pakistani Military, North Korea, and now Erdogan are classic examples. Myanmar junta, too, has the same propensity. Its disgraced General from the Rohingya atrocities was about to retire.

A perfect opportunity
Chinese support, tarnished credibility (from Rohingya atrocities), huge loss at elections, and the aspiration to be a lifetime leader all provided a perfect culmination for a coup. Min Aung Hlaing became the de facto leader of the Junta.

Do we have a problem with the Military?
Well, let’s rephrase this. Why should Myanmar being ruled by Military or Democratically elected leader be a global issue? Aren’t militarily ruled nations not properly managed as compared to some of the democracies? I, too, share this concern along with you. However, with authoritarian rule, the mechanism of transparency, audit, and accountability are all vested into a single person’s hands. It is not about corruption, but it is about conflict of interest and the monstrous ability to hide and suppress that compromises the common man’s life.

Democracy gives that right to the common-men to decide her/his fate. Democracy offers an ability to coexist; by no means democracy is a perfect system or a panacea of hope.

Shashank Heda
Dallas, Texas

Who is Myanmar junta chief Min Aung Hlaing? 5 things to know
https://asia.nikkei.com/Spotlight/Myanmar-Coup/Who-is-Myanmar-junta-chief-Min-Aung-Hlaing-5-things-to-know

https://asia.nikkei.com/Spotlight/Belt-and-Road/Renewed-conflict-in-Myanmar-slows-China-s-Belt-and-Road-projects

https://thediplomat.com/2019/05/myanmars-fragile-democracy-needs-the-us-not-china/

https://www.foreignaffairs.com/articles/asia/2015-12-01/democracy-myanmar

COVID- A tale of two worlds

Breaking the transmission cycle by interrupting these traversals of the virus is critical. Travel restrictions, strict screening and surveillance, and mass vaccination and precautions are all CRITICAL to the successful CONTROL of COVID. Let’s keep our fingers crossed and follow all the right protection.

COVID- A tale of two worlds

(Words – 678; reading time 3-4 minutes, Why should you read? The pandemic is not over and out, do not drop the guards)

While the western world is dealing with one of its worst phases of Covid – 19, the so-called Covid-2, several nations, including India, are almost calling the game is over. Let’s revisit and understand the pandemic’s delicate dynamics and the evolving mutant variants of the virus.

As of late January 2021, hospitals in London and its suburbs were out of any beds for admitting the patients infected with Covid. The modeling predicted one of the worst shutdowns in the history of the great kingdom. Boris Johnson, a nationalist and a populist by inkling (a Trump category leader) too, caved into the worst pandemic. My doctor colleagues from Kent are working almost continuous long hour shifts (18 hours at a stretch). Elsewhere in the UK, the scenario was no different.

Brazil has just surpassed India as the second-worst country after the US to be affected by the virus. Europe, with its defining economies, is jettisoned with the virus. France, Germany, Spain, Italy, and all the Scandinavian countries are on the highest alert, with restricted and severely clamped down inbound and internal traffic, almost reducing the countries to secluded pockets.

Here in the US, of course, statistics are grim, the economy has bounced back a little, but guards are not down, like in India and its peninsula. A quick view of the hospital bed availability for most regions, states, and cities are still red, not to mention LA and its suburbs, which is chronically deprived of beds for almost a few months.

Let us unfold the mysterious virus.

While the simmering stories in the western world are true, it is equally true and a reality that life in India (and the peninsular countries) has bounced back to normalcy.

What can be the reason?
Yes, its is an existential dilemma, that has created a completely divided world with distinct response and behavior to the virus.

Continuous mutation and evolution of the virus
While we know all the mutations such as B 1.1.7, D614G, N501, and its variants, and several subspecies of the evolving new generation-of the virus, what is least understood is that avowed variant that is circulating in those countries where life has bounced back to normalcy. Let’s call this hypothetical mystic variant “Benign Covid-21” (I just coined this word, so no Google search will yield any additional documents). This haplotype, if widely circulating in these populations, maybe an answer to the nature mitigation of the virus. Ultimately, as my friend and a noted prominent vaccine expert Dr. Anand Kawade said, the virus has to live amicably with its hosts. It, too, has to find a symbiotic relationship to survive. This metaphysical aspect cannot be discounted though it needs scientific validation.

Should we drop our guards?
It is too early to say if those in India (and countries with a similar pattern of Benign Covid -21, should drop their guards. One thing is clear, global lockdowns (and lock-jams) are definitely not an answer. At the outset of the pandemic, i had called out the hypothesis if the degree of separation concept, retrospectively, in hindsight, it seems obvious to lean and review that model. Summarily, the degree of separation talks about the interaction amongst the population and not the distance that influences the outcome of the disease dynamics during the covid pandemic. Thus, putting entire cities, regions, and states in mass lockdown is not a pragmatic idea.

Shashank Heda, MD
Dallas, Texas
Founder and Chief Executive,
COVIDRxExchange, a global nonprofit initiative for disseminating the expertise and insight for doctors in the care of COVID)

To Visit our repository of over 1000 best practice documents, please visit – http://www.covidrxexchange.org

To join our global community of over a thousand doctors, please use the below link, https://join.slack.com/t/covidrxexchange/shared_invite/zt-le49a2h0-QUsrvUe_5xsdBwgWvEQxrQ

Rubber Meets the Road.

Let’s start where I want to end this topic, and I know you won’t like me saying this. The pandemic is likely to swagger around more than anticipated. If we anticipated it to end sooner, if not early 2021, it bores disappointment. It’s just not the delay in rolling out the vaccine. Let’s see the multitude of issues why the pandemic is likely to last longer.

Vaccine Nationalism is an integrated world is unlikely to protect a nationality unless the borders are strictly closed. Well, any isolationism and walls are unlikely to stop the Humboldt of global integration. If the rich or the have (those with technology), are planning to cover their nationals, the virus is likely to linger longer in those deprived.

What are the consequences?

Most of us are aware of the new mutations in the virus that imposed an immediate lockdown in the UK. This mutant variant is secondary to the virus gaining survival by mutating and escaping. Such mutants are like to hamper our interventions right from screening to vaccination.

Is it a global vaccine rollout?

Of course nor, the vaccine rollout has started in the EU, UK, US, Brazil, Mexico, Canada, Japan, China, and a select few countries. However, several countries are lagging behind either because they have no funds or no technology or logistics to deploy a complex vaccine delivery program. Add to that the regular protagonist of the ‘conspiracy theory’ school, and you compound the problem to a level of practical reality.

Surprise – Many doctors are evading vaccine

I was surprised to see practicing doctors avoiding vaccines. This is not an isolated but a pervasive phenomenon. There are still lingering doubts about the virus getting integrated into the human genome, which is unlikely to happen. Another misconception is heavy metal contamination of the vaccine. You and I are more exposed to the unknown quantity of heavy metals in our produce from Mexico or the disposable material we are exposed to. First, I may disagree if such contaminations are possible with the vaccines, and even if those were, it is unlikely that you get a significant dose to perturb your system. Another misconception that is going around – that the vaccine is made in cow or pig. I just piety these folks who work on churning the rumors mills devoid of research, reasoning, and rationale.

The cold chain and logistics

It is a formidable challenge to manage the cold chain in a diverse world like ours, even if we presume that vaccination will be adopted uniformly. Having worked as a molecular oncology fellow, I know that especially the RNA vaccines from Moderna and Pfizer need a distinct cold chain, and any disruption is likely to compromise the efficacy of the vaccine significantly. Now consider the vast and remote corners where the vaccines have to be carried out if we were to target complete eradication of the virus.

These are not easily surmountable challenges and devoid of a strategy and execution plan that is customized to individual locales (countries, regions, etc.), it is unlikely to achieve the desired goal of covering 60%-80% population. If the virus lingers, it will mutate and likely stay with humanity for longer than the expected period of time. It will evade our detection gold standard, such as RT PCR. It may create resistance to drugs such as Remdesevir, or worst, become more aggressive and, last, render our vaccines useless. That’s why we vaccinate ourselves annually for flu.

Let us hope for the best.

Hope is not the best strategy; instead, hope is the worst strategy. A thorough understanding of the global target population dynamics vis a vis the vaccination program is required. Strategies alone cannot help; execution of the plan will be the harbinger to success. Until then…

I wish you all a very safe 2021!

Shashank Heda,

Dallas, Texas

The Culpable Trend Continues

Of course, we saw during Covid how China suppressed the Covid investigation, manipulated the data and cleared the crime scene.

Recently, I saw news that China is targeting a GDP of 8 and above fir 2021. It is no news that China is under severe debt, industry is recuperating to gradual recovery, (and of course it will be, because its global customers are still reeling under recession), and it has quadrupled its expenses during a time depleted revenue flow and persistent pressure of aggressive spending on aggressive militarization.

Credits: John H Tuckers, The Riverfront Times

Now comes the real news

It has suspended the regulating agency which rates the progress. And why not? It has to, if it needs to pain all hunky dory, like the old style communist propaganda.

Eventually, we know, with one stroke of Perestroika, the entire communist castle came crumbling down. It’s just a matter of time, such artificial models have no sustenance, they glitter like a nighttime bugs, and lose the flare with the arrival of twilight.

Shashank Heda
Dallas, Texas

Chinese regulator suspends rating agency over Yongcheng default
https://asia.nikkei.com/Business/Markets/China-debt-crunch/Chinese-regulator-suspends-rating-agency-over-Yongcheng-default

Sleep Walking

Let’s scratch the surface

You all know how the bulls are raging on the stock markets globally. Most indices have skyrocketed while the economies of the world are reeling under covid.

Credits: Ben Carlson, https://fortune.com/2019/10/29/stock-market-rally-2019-christmas-eoy/

In a world full of non-ideal things, this one is no outlier, not because the markets display anomalous behavior but because the sentiments are so disconnected from the ground realities.

They say Covid is a disease of the affluent. Though I may disagree with that observation, however, stock market sentiments are the affluent’ sentiments. None of us want to see it lose, so we succumb to sentiments than the bottom line of individual companies comprising the index.

What’s so wrong if stocks are rising, especially in a sagging economy?

Absolutely a great question. Let’s understand the dichotomy and the disconnect. Presume my shares from a listed company shot up by 27% in the last nine months; obviously, I gained those. That offers a relative advantage over those struggling to survive and sustain.

However, let’s understand the stimulus bill. If only we have a great economy, ideally, we would not have the required stimulus. Interest rates would not have been low, millions would not have defaulted on their payments and mortgages, and unemployment would have been on the decline.

When the indicators are not connected with the ground reality, we are bound to land up in a ditch. Just imagine my leg is on the gas paddle, and I am pressing it hard; my car is cruising at astonishing speed, but the indicator says 22 mph.

When the indicators do not capture realities, we live in the castle, when the bourgeoisie falter, that revolutions are born. To douse the fire, we provide stimulus and subsidies. The vicious cycle keeps going endless while we churn a class of have-nots and increase the chasm with the have’s.

https://fortune.com/2019/10/29/stock-market-rally-2019-christmas-eoy/

Global stock markets form K-shape as investors search for growth
https://asia.nikkei.com/Spotlight/Datawatch/Global-stock-markets-form-K-shape-as-investors-search-for-growth

Glutted Economy – 3 (India)

A grave mistake in the imposition of a universal and global lockdown is the impact on the economy. Let us be open, the lockdown was boisterous, more with nationalistic fervor and less on science and an understanding of the principles of disease transmission. Sometimes back, I wrote about the concept of degree of separation and retrospectively, that explains the unsolved and enigmatic transmission in Europe and non-transmission of the virus in Shanghai despite Wuhan being badly impacted.

Learning from the ‘Kelly Criterion’

First unraveled in 1956, The Kelly Criterion helps with applying the IT principles to gambling and investment. In a simple sense, it is about risk management and seize and sizing the opportunities despite the challenging situation. Though the principle cannot be used as is, the underlying fundamentals remain the same.

It is unwise to blame policymakers or the executioners; understanding the crus of the new problem through a different set of eyes is thus critical. As, Einstein famously said, “We cannot solve our problems with the same thinking we used when we created them.” SARS CoV2 posed a similar challenge. We used the old yardstick to measure the new problem. Relying too much on R nout, to define such a critical national and global policy was such a deficit in our thinking. We have seen, despite lockdowns, we haven’t seen a complete break in the transmission of the cycle. Something is definitely amiss. Not that the virus has learned some tricks better than the natural laws, but the fact that we haven’t understood the complete spectrum, of dodging the virus. The economy is the lifeblood. How can we survive without an ongoing economy?

Cognitive dissonance: Dichotomy or Anomalous Behavior

We see the severe and widening chasm between several key parameters, typically called dichotomous or anomalous behavior. I was talking with my uncle back in India. He stays in our ancestral village where we own agricultural land. I asked him how is Covid-19 in our native village? Is it disrupting the agricultural activities of the Rabi crop cycle? He said, there is no COVID-19 in the village or the surrounding villages, despite our village is just 9 miles from a moderately big city of 1.5 million. On further questioning, he said, those working in the town, keep themselves isolated if not quarantined. If this is a fair data point that I can trust, and if I can extrapolate, then it is a seminal observation that will provide deep insight from such lockdown of the villages? Does that mean, we have to let the village interact with the Town? What would be the right model to break the transmission cycle and keep the economy moving in the countryside? Understand, though integrated, the metropolitan and countryside economy are two different arms that offer support to the national economy. More so, the countryside economy is still at the center stage of the national economy and provides a foundation for the national economy and not vice versa. At least if one arm continues, we are still in good shape. This is a key observation for any agriculturally leaning economy.

Let us visit another example. Many amongst you might have seen the stock market index. I call it sentiment, not a true reflection or an indicator of the business activities. Look at the divergence between the stock market index and the ground realities. This is not just afflicting the US, most economies are in this state. India is no exception. China can be, because everything is well masked and we truly don’t know the true nature of the devastation, despite receiving contradictory cues about the health of the Chinese economy. The business has been almost stalled, businesses across have been hurt because of the tortuous and tumultuous perversion of the virus as it is wading its way through the different strata of society. Is there a connection between the indicators and the health of the economy?

Such divergences create cognitive dissonance on the collective consciousness of the common man and result in defiance, that ultimately takes a toll, on the health as well as the economy of the nation and the global economy. Especially, this comes after the world had just recovered from the massive recession of 2008-09. Since 2000, post dotcom bubble burst, the economy has pretty much been dragged, by demand and has truly not been sprouting spontaneously.

Below excerpts from New York Times, “India’s economy shrank 7.5 percent in the three months that ended in September compared with a year earlier, government figures showed on Friday. The data reflects the deepening of India’s severest recession since at least 1996 when the country first began publishing its gross domestic product numbers. The new figures firmly ensconced India’s position among the world’s worst-performing major economies, despite expansive government spending designed to rescue the thousands of small businesses severely battered by its long, hastily imposed lockdown”.

How well is India responding to COVID-19?

https://www.financialexpress.com/economy/covid-19-pandemic-may-be-good-news-for-indias-economy-or-may-be-bad-for-china/1954207/

https://economictimes.indiatimes.com/news/international/business/global-economy-could-shrink-by-almost-1-in-2020-due-to-covid-19-pandemic-united-nations/articleshow/74943235.cms

Ahh, I so much love China!

Ahh I love China. A totalitarian state never has to deal with the dilemma of a democracy. Life if simple, just lease your intellect to the state and work like a hen in the poultry. You have the best of the living conditions, nutrients, also a few micronutrients and absolutely controlled temperature. I love life in Chicken Farms! They have everything to serve the state (owner) and can live their stipulated life until the state desires. Let me admit, more than the blog, I liked the links shared, especially from Freedom House, Philosophy forum and the Economist.

Ahh, I so much love China and Russia

Well, liberal democracy has to walk along with all the stakeholders, unlike a totalitarian state. However, when it comes to imposing critical and essential restrictions, as was done by New York that Gov. Andrew M. Cuomo, to contain and control Coronavirus spread in New York, it was struck down by the conservative supreme court bench in favor of the Orthodox Jewish Organization and the Roman Catholic, the former having a high incidence of COVID.

As I read from the New York Times (link cited below), “The restrictions are strict. In shifting “red zones,” where the coronavirus risk is highest, no more than 10 people may attend religious services. In slightly less dangerous “orange zones,” which are also fluid, attendance is capped at 25. This applies even to churches that can seat more than 1,000 people”. “The Constitution does not forbid states from responding to public health crises through regulations that treat religious institutions equally or more favorably than comparable secular institutions, particularly when those regulations save lives,” Justice Sotomayor wrote. “Because New York’s Covid-19 restrictions do just that, I respectfully dissent.”

I am not sure how these numbers arise? 10, 25, 50, 100 etc. I have seen such flaunt numbers from different administrations, only to create fault lines and not fix the solution. At least my simple logic dictates that these numbers are irrelevant, and should directly be correlated with the index case or the sentinel case.

Is a numeric threshold right?

I was talking with my uncle back in India and I realized, the small village where our farms are, have no COVID in their vicinity. Obviously, I was concerned for the second crop and other agricultural activities. The best practice is to quarantine the cities and not the countryside, which as free of disease. Let the commerce flow and let the business flourish if the impact is minimal.

When I talk with my network in China, I see that the lockdown has strictly adhered to. Well, who is right? Liberal democracy with one foot backward and one foot forward, or a totalitarian state with both feet aligned?

There can never be a cookie-cutter approach or a standardized way to resolve this conundrum. Our only recourse is to evaluate each situation separately? A lot of human intelligence (Can AI help?). Irrespective, it is an individual choice versus the state responsibility towards all. Science cannot be ignored despite knowing its incompleteness. However, we can only see on the basis of current visibility.

It is obvious, that a bench is favoring a decision despite its lack of requisite (medical) background, competence and expertise to assess public health and its accountable for the people. At least for now, the public concern is thrown out of the window.

It is hard to customize and still retain the luster of the fundamental amendments (the first, second, etc.). However, it is a rope walk and if you ask a lazy person like me, I love China!

Shashank Heda

United States Government: Why form a government?

https://thephilosophyforum.com/discussion/6368/centrist-and-small-government-debate

https://freedomhouse.org/report/special-report/2017/breaking-down-democracy

https://www.economist.com/essay/2014/02/27/whats-gone-wrong-with-democracy

Future’s Heady Mix

Unless President Elect consciously makes a choice to select his options, and unless enough time is spent in understanding the changed realities on the new world, he is unlikely to make significant dent to resolution of existing scenarios. In fact, there is a potential for situations going downhill and precipitating the Trump phenomenon. Understandable, four years are not enough for a significant change to happen, but four years are enough for laying a foundation for the future global and national engagement.

Good Morning Biden, the world is a new place now!

Now that the hand recount from Georgia is over, the winner is clearly Joe Biden, unless a sabotage or a coup is underway. With Georgia in Joe Biden’s plate, the validity of the count is much reinforced. That is the reason, why I feel this is a fresh morning for Joe, the President Elect.

What’s in store for the future?

We all know Joe was a Vice President under President Obama. Of course, that eight years tenure was remarkable in achievements and misses. However, it carries the risk of bringing the same mind set as earlier and the key concern with problem space, is that if you try to solve the problems with the same fervor and approach as earlier, it is bound for failure. Unless President Elect consciously makes a choice to select his options, and unless enough time is spent in understanding the changed realities on the new world, he is unlikely to make significant dent to resolution of existing scenarios. In fact, there is a potential for situations going downhill and precipitating the Trump phenomenon. Understandable, four years are not enough for a significant change to happen, but four years are enough for laying a foundation for the future global and national engagement.

The last decade saw major populists taking over several democracies. A quick revisit will help us understand, democracy has given way to demagogy, that’s barring Putins Russia and Xi’s China. The rise of Duterte in the Philippines, Bolsonaro in Brazil, Johnson in the UK, Modi in India, Erdogan in Turkey are just few handful examples. Of course, I am not counting Pakistan, which has a democratic face to the military dictatorship.

Added to these are more spicy stuff happening in the Middle East. Syria, and Iran are consolidating their grip, whereas, feudalist and autocrats are advancing their handshake to those espousing the values and torch bearer of democracies, such as France and Germany.

Even those countries who are deeply committed to democratic ideals are leaning on China for economic support. Spain and a few more western European nation are leading that trend.

Given this heady mix of toxic cocktail, the ideas of yesteryears, such as replacing democracy, world politically and militarily dominated by the US, unilateral wars etc are unlikely to be productive.

Biden is taking the mantle of leadership under such circumstances. A fresh and distinct mindset is required. Can this be achieved by adding yesteryears bureaucrats? It’s needs deep introspection and reflection of the events that have unfurled on the global stage. Just accepting the populist leaders and offering a collaborative handshake is not enough.

The world has to understand the phenomenon called Trumpism (not related with Donald Trump), and see why we left behind such a huge swath of population, that such populist and radical nationalists have evolved?

This is a rude reality that Biden will awaken to while taking charge of the US on Jan 20, 2021.

Shashank Heda,
Dallas, Texas

Charting America’s Debt: $27 Trillion and Counting

https://www.visualcapitalist.com/americas-debt-27-trillion-and-counting/