Absolute Isolation Works Absolutely

As of this writing the total deaths in the US have mounted to 10,335. Never before mankind had seen such a fast moving, swiping infection. We knew Ebola, we knew Marburg viruses, and a few Prion diseases but collectively, we had never faced such a dreaded disease with high mortality. We were caught almost unprepared or at least we ignored with complacency. I have shared my thought on why isolation is important to contain this disease and how countries like Singapore, South Korea and japan are dealing planning isolation and intelligence in dealing with this crisis.

Absolute Isolation Works Absolutely

As noted in my earlier blog, viruses are obligate parasites that need (MUST) a host cell to survive. They go through their phases of replication and eventually, after not getting proper host cells to infect, die a natural death.

Strict Isolation Social Distancing

I have had many folks across the geographies asking me a few questions?

  1. Why is the incidence of Coronovirus so high in the US?
  2. Are certain ethnicities (such as Indians) immune to the Coronavirus?

I will emphasize the control of Coronavirus based on the viruses’ obligate dependence on live cells for survival. We all know that if we practice Isolation absolutely, we should be assured of not having the disease.

Two situations preclude our ability for Isolation –

  1. Our needs for Essentials
  2. Fundamental Sense of Liberty

I owe you all a clear and concise write up on the best practices and pragmatic guidelines on “How to Manage Essentials” giving an end to end perspective, that provides the best way to avoid getting the virus inside your home. Give me until later this late evening to fulfill that commitment.

Let us talk about the “Sense of Liberty”. The US, the EU, and most developed nations have an enshrined fundamental Right of liberty to move.  Isolation or ‘Shelter in Place’ equals to ‘House Arrest’ for them. The later nullifies isolation and thus provides a continuation of the propagation of the virus by allowing it to jump from people to people (aerosol, airborne, contact and fomites).

Aerosols Airborne Fomites

I see a dichotomy based on the above two practical limitations that are increasing the spread of Coronavirus in the US. Select countries like India and Japan are strongly considering the imposition of emergency. Whereas, many have implemented strict isolation even if the idea of isolation has emerged from behind the Iron Curtain of China.

The Bhilwara Model

The Bhilwara Model for containment of COVID-19 refers to imposing a curfew in the district including suspension of essential services, extensive screening, and house-to-house surveys to check for possible cases, and detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected. A similar model was followed in Singapore, South Korea, and Taiwan. Singapore had gone a step ahead and deployed its intelligence sleuths to extract the contact tracing, whereas, the draconian Chinese Govt deployed Bluetooth tracing abandoning the privacy laws (they do not exist in China, except while the couple is conjugating, I believe!).

The success of the Bhilwara model is attributed to controlling an outbreak within the first four days of the initial incidence (remember the Rho factor.

Absolute isolation works absolutely. Yes, it does but can we forego our sense of liberty? Can we minimize our needs and limit our consumption? Please visit my next blog on “Managing the Essentials”.

 

Also read – Support your service folks (maids, handyman, lawnmowers etc.) https://mymilieu.org/2020/04/02/supporting-service-folks-during-crisis/

Why is Coronavirus highly infective? https://wp.me/p7XEWW-1go

Additional Reading:

How do I know if I have a Coronavirus infection? Before reading further, I strongly advise and recommend that this should not be construed as advice. Your best recourse is your doctor or health care professional.

Doctors in China used a triage system for fast screening. This was published in the Lancet. Below flowchart from the Lancet.

COVID Symptoms Flowchart Lancet JPEG

 

 

WHY is COVID-19 HIGHLY INFECTIVE?

The Spikes which you saw on the surface of the virus have a high affinity with a receptor on the human cells (ACE2). The direct implications are a definite attachment and infection of the cell. Once it has latched on to the cell, it infests and starts replication (reproduction).

Keeping my promise of sharing ACTIONABLE  INFORMATION, let me start with why COVID is so infectious.

Airborne Dispersal

MOSTLY, if not ALWAYS INFECTION:  After exposure to COVID-19 (Highly Infective). The Spikes which you saw on the surface of the virus have a high affinity with a receptor on the human cells (ACE2). The direct implications are a definite attachment and infection of the cell. Once it has latched on to the cell, it infests and starts replication (reproduction). Visit this Youtube for learning the virus replication. https://www.youtube.com/watch?v=J4BN4dARpio

What do I do as a common man?

Isolation (lockdown), using masks and following all CDC, WHO, NIH, State, and Local guidelines. Build a staging area outside the home, do not get the virus inside the home. All essentials should be cleaned appropriately before those get ingress into your home. Presume everything from outside is contaminated until cleaned.

2) Lysogenic phase: Breaking the cells after making thousands of copies (lysogenic phase). Please visit https://www.youtube.com/watch?v=sQ0ShukSA5I. 

What do I do as a common man?

Clean after contamination. I follow the below steps – outer clothes removed in the Garage and set for laundry immediately, shower with soap/shampoo, nose blow, and peroxide gargles. The last two steps remove any adhered viruses from inside the nose and throat.

3) Early Symptoms: Step 1 follows in thousands of new normal respiratory cells. Fever, Nasal Congestion, loss of smell (because the olfactory cells are affected). Cells start producing exudate (copious secretions).

What do I do as a common man?

Get tested and isolate from other caregivers from the family and friends. Stay isolated (if mild symptoms and or test positive) until results are available or at the least 15 days after the lasts symptoms. If required, seek immediate help. DO NOT SELF MANAGE (explanation later).

4) Initial Phase of Lung Congestion: The virus travels inside to the Lungs and infects the respiratory lining cells. Visit the below video to learn more https://www.youtube.com/watch?v=4HPlSm94czk. Also, see https://www.youtube.com/watch?v=Xj1nUFFVK1E.

5) Cytokine Storm: Huge secretion of fluids (doctors call this as Cytokine Storm) blocking oxygen exchange. Ventilators are required to support oxygenation. However, I have had first-hand reports that it is painful to watch patients struggling to breathe even on ventilators.

What do I do as a common man?

Seek early help, Please do not self-treat? Why – You may have a sudden catastrophic fluid collection in the lungs. What else do I do? Of course isolation and other guidelines to be used as required)

6) Acute Respiratory Distress Syndrome and Mortality/Morbidity: This is the most dreaded step.

What do I do as a common man? Be careful at the initial steps (1-3) (Shashank Heda, MD).

COVID19 Local Statistics

Rule of Thumb

Folks, my neighbor taught me one simple rule of thumb – What is essential? Can I survive without this? If I can, then it is not essential.

Can we – STRINGENTLY FOLLOW THIS?

  • ISOLATION (LOCKDOWN)
  • PROPER DECONTAMINATION
  • EARLY PROFESSIONAL HELP
  • SPREADING AWARENESS (ask questions if required)
  • SUPPORT SERVICE FOLKS
  • No COMPLACENCY (THAT I HAVE BETTER IMMUNE SYSTEM THAN OTHERS)

 

Stay Safe!

—    —    —    —    —    —

 

Based on the latest research from Nature and Cell BioSciences and analyzing the data (first hand) from Texas, I see it important to be all the stricter with isolation. Let me take a few issues individually.

Why SARS-CoV2 (COVID-19) is so dangerous?

Primarily because of the

1) Ridge on the S protein that allows it for tighter binding to the ACE2 receptor on the human cell
2) Suppression of antiviral immune response and
3) Concurrent activation of the pro-inflammatory response
Simply speaking – SARS-CoV2’s S protein (Spike protein) after binding with the ACE2 receptor on the human cell, changes its conformation to and goes into a tight affinity, primarily because of the ridge present on the S protein. That makes the SARS-CoV2 very infectious. Now, add to that, the florid inflammatory exudate (cytokine storm) and you get a double whammy. SARS-CoV is known to be exceedingly potent in the suppression of antiviral immunity and the activation of proinflammatory response.

Researchers are working to block the affinity of S protein or reduce the affinity. Another direction for research is controlling the cytokine storm. Our Milind is working on the Stellate Ganglion Block. You should bring him back here to ask more about them later.

Excerpt from Nature below (citations removed, reference link included) – A key to tackling this epidemic is to understand the virus’s receptor recognition mechanism, which regulates its infectivity, pathogenesis and host range. SARS-CoV-2 and SARS-CoV recognize the same receptor – human ACE2 (hACE2). SARS-CoV-2 receptor-binding domain (RBD) (engineered to facilitate crystallization) in complex with hACE2. Compared with the SARS-CoV RBD, a hACE2-binding ridge in SARS-CoV-2 RBD takes a more compact conformation; moreover, several residue changes in SARS-CoV-2 RBD stabilize two virus-binding hotspots at the RBD/hACE2 interface. These structural features of SARS-CoV-2 RBD enhance its hACE2-binding affinity. Additionally, we show that RaTG13, a bat coronavirus closely related to SARS-CoV-2, also uses hACE2 as its receptor. The differences among SARS-CoV-2, SARS-CoV, and RaTG13 in hACE2 recognition shed light on the potential animal-to-human transmission of SARS-CoV-2. This study provides guidance for intervention strategies targeting receptor recognition by SARS-CoV-2.

(Simplified – @ Shashank )

https://www.nature.com/articles/s41586-020-2179-y

—    —    —    —

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074995/

The origins of SARS-CoV-2 and COVID-19. To make a long story short, two parental viruses of SARS-CoV-2 have now been identified. The first one is bat coronavirus RaTG13 found in Rhinolophus affinis from Yunnan Province and it shares 96.2% overall genome sequence identity with SARS-CoV-2 [3]. However, RaTG13 might not be the immediate ancestor of SARS-CoV-2 because it is not predicted to use the same ACE2 receptor used by SARS-CoV-2 due to sequence divergence in the receptor-binding domain sharing 89% identity in amino acid sequence with that of SARS-CoV-2. The second one is a group of betacoronaviruses found in the endangered species of small mammals known as pangolins [4], which are often consumed as a source of meat in southern China. They share about 90% overall nucleotide sequence identity with SARS-CoV-2 but carries a receptor-binding domain predicted to interact with ACE2 and sharing 97.4% identity in amino acid sequence with that of SARS-CoV-2. They are closely related to both SARS-CoV-2 and RaTG13, but apparently they are unlikely the immediate ancestor of SARS-CoV-2 in view of the sequence divergence over the whole genome. Many hypotheses involving recombination, convergence and adaptation have been put forward to suggest a probable evolutionary pathway for SARS-CoV-2, but none is supported by direct evidence. The jury is still out as to what animals might serve as reservoir and intermediate hosts of SARS-CoV-2. Although Huanan seafood wholesale market was suggested as the original source of SARS-CoV-2 and COVID-19, there is evidence for the involvement of other wild animal markets in Wuhan. In addition, the possibility for a human superspreader in the Huanan market has not been excluded. Further investigations are required to shed light on the origins of SARS-CoV-2 and COVID-19

 

 

Supporting Service Folks during Crisis

We all have lawnmowers, handyman, maids, and others working with us regularly. During this COVID-19 crisis, all have a significant reduction in their work or most like you, are lockdown. It is frustratingly painful to run families during such times.

Service Support

Unfortunately institutionalizing any charitable donations in the US, suck up 80% of the revenue for their operations and maintenance. So, after giving a thought, I realized, the best way is to support our service folks directly, rather than any institutional donation. My best suggestion would be to support your folks. On the contrary, my support on the farm was busy with work to take care of him. I did not offer anything to him since he is already on the job.

Recently, I unconditionally paid money to my handyman and maid. Both were extremely thankful. My handyman just moved to Georgia and he was broke. It came at the best time. Our maid has to run a family of 3 kids as a single mom. She was extremely thankful. Both offered to work after this is over. However, I made no conditions for this support. Though I did not promise, I will do a similar amount in the next 2-3 weeks.

If you haven’t done it, now is the time to think of supporting, little in your own way. Let us support them to support their families. Indirectly, it helps the economy keep going.

Why am I blogging on health and diet?

For most healthy living is having a balance between eating and exercise. Well, it goes beyond that one will eventually comprehend the importance of spirituality and expand the dimension of health. Suffice it to say that, the most elementary blocks of health starts with Diet and Exercise and this blog is focused on diet and exercise.

Because it is core and critical to our efforts and initiatives in life.

Generalizing from decades of observations, understanding the molecular mechanism that cascades the physiologic pathways, and adding an angle of a spiritual journey to our living, I too believe that the source is within us. We pamper ourselves with indulgence and defend it with reason. That in itself is a root cause for systemic illnesses such as for overweight/obesity, insomnia, hypertension, and diabetes (well in exceptional cases, we do have hereditary, genetic and developmental factors that contribute).

However, once these systemic maladies set in, it takes a long time to revert to the original baseline. Here again, we try indulging in radical results with resultant generalized impact. Liposuction, extreme diets, such as keto diets, etc. cause untoward effects on the body. Dependence on drugs such as antidiabetic or antihypertensives keeps increasing, partly because of tolerance and mostly because the root cause is not addressed.

Restoring health is a discipline, not a snapshot event in time. It needs a comprehensive multidimensional change. I know if I haven’t slept adequately how that affects my work. Some maladies have an evident outcome, others have a long-lasting impact. Let’s have that balanced perspective to dart towards achievements.

I am often reluctant towards opting for radical options such as surgery (with exception), so also I am against drugs/medicines.

Every life journey is unique, complicated by a confluence of conscious and subconscious flows, that we alone can decipher and discern. Those moments of reflection should ideally help in putting up a roadmap towards the restoration of health. While that is the permanent way, we can and should rely on drugs or other means, while transiting towards that phase.

However, jumping directly to radical options is ill-founded and deficient. A gradual incremental reversal, though difficult, can be achieved through consistent behavior with discipline. Well, it is easy to say but difficult to implement. However, that’s the test of your grit and determination, that we all are born with.

Welcome – Culture of ‘Forwarding’ messages! 

Forward is gradually getting deeply embedded within our social interaction. This isn’t an isolated phenomenon, this is gradually getting all pervasive and as part our inherent tendency to thoughtlessly contribute towards just not gossip, social malice but apathy and an agony to those affected. We were in the culture of rumor mongering but, now – welcome to the culture of forward instinct. It is a new norm, a new reality.

Barbaric not tribal instinct

I got a below message on our home owners community group. This is despite having created norms (we don’t call them rules) and governance. The intent of that group is to serve home owners that matters them directly. Below, please see the message. I removed personally identifiable information to protect privacy.

Barbaric not tribal 01

I knew it was fake but more so, I was concerned, why a message on kidney donation (from India) be seen in US. I contacted the number shared in the message and below is the reply from the gentleman, screenshot for your perusal. Can we call this barbaric? Definitely, this is not tribal. Tribal folks have better norms amongst themselves, so let’s call this criminal.

Barbaric not tribal 02

Is Due Diligence that difficult?

We need to do a little due diligence before indulging in public service of forwarding this message. Our forwards may be causing agony, trouble or harm to those who are directly affected. Even if those are mild, we are burning the bandwidth by taking away time from doing something concrete and productive.

Sometimes, I feel, our sense of social service is restricted to forwarding indiscriminately. We suddenly get that urge, that strong impulse –  to forward, may be “kisi ke to kaam ayega”. That forward relieves us of our impulsive instinct and provides a sense of having achieved something for social cause.

The Big Concern

With the volume of messages and our decrease bandwidth, just one instinct dominates, “forward”.  I feel, our amygdala is taking over our left frontal cortex, the part that is responsible for intellectual pursuit and decision making. There is another part that dominates the story. Normally, a part in our brain called amygdala, are responsible for flight or fight type emergency responses as well as our perception of fear. When Amygdala dominates Left Front brain, it is equivalent to ‘frontal lobe injury’. Some of these patients end up losing that decision making ability. Most concerning aspect for me is – , Are we getting rewired with these voluminous social media messages?

The Irresponsible within us

Our social media adds more and gives us less. The downside is social agony, malice, cognitive dissonance and pulls us back as those lacking sensitivity. We can’t blame social media, it starts with us. Absolute barbaric behavior such as stone lynching has been widely reported due to irresponsible messaging. We are being exploited and our opinion are molded and dominated by intentional messaging. One of the dominant reason for the recent rightwing political wave across the globe is capturing of intellectual pursuit. Sometimes back, I wrote a blog on this. It is still relevant, so I am sharing the link. https://wp.me/p7XEWW-Uc.

Request all not to forward without due diligence, even if that means good for the community.

Risk of West Nile is real

I was in the front yard on Sept 9, 2018 and I had severe bites from mosquitoes. I mustn’t be the lone person. After talking with several folks within the community, I realized, it is an area wide problem. After reviewing the mosquito control measures from the City of Irving, I realized, our area was treated on August 15, 2018. However, after talking with City official, on spraying again and having an integrated management plan (a dual plan where city and homeowners concurrently treat on multiple occasion), I was told by the City officer that the CDC has set limitations, unless West Nile or Zika is detected, they cannot treat again. My question was simple – Do you want to wait for a family member to fall sick and than start treating the area or do we want a prevention before it happens? I talked with Leroy MacFarland. Talks with Mr. Dickens, Ms. Adrian are in progress. I will keep you posted. 

 

Zika

Risk of West Nile is real

How can I say so confidently? The Mosquito menace is huge; Dallas County Health and Human Services detected a positive West Nile Virus sample on Rochelle Street (See picture and link from City below).

West Nile in Irving

What is West Nile?

Obviously, we heard a lot and many amongst you know it. However, to recap, here is an excerpt from Center for Disease Control (CDC) “There are no vaccines to prevent or medications to treat WNV in people. Fortunately, most people infected with WNV do not have symptoms. About 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness”.

You can reduce your risk of WNV by using insect repellent and wearing long-sleeved shirts and long pants to prevent mosquito bites. Please visit CDC on https://www.cdc.gov/westnile/symptoms/index.html to know more about West Nile and its health impact.

Fortunately, in most people, it is not dangerous, excerpts from CDC…”Most people  (8 out of 10) infected with West Nile virus do not develop any symptoms. About 1 in 5 people who are infected develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea, or rash. Most people with this type of West Nile virus disease recover completely, but fatigue and weakness can last for weeks or months. About 1 in 150 people who are infected develop a severe illness affecting the central nervous system such as encephalitis (inflammation of the brain) or meningitis (inflammation of the membranes that surround the brain and spinal cord)”. https://www.cdc.gov/westnile/symptoms/index.html.

What do we do?

Of course, if you have suspicion for West Nile symptoms, you should contact your healthcare provider.

How do we ‘Prevent’?

That’s the reason for taking this initiative. Mosquito control is dual responsibility –

  • Local Government and the
  • Home Owners.

An integrated Mosquito prevention program is required for controlling mosquito menace. While City is doing its own rounds of fogging and environmental control, we as Homeowners have singular responsibility. We need interventions inside our home where City has no jurisdiction.

Both these activities have to be coordinated. We need the fogging program to happen in tandem. That means, while the city is treating your area, we need to simultaneously treat our yards. City alone cannot, individual home owners cannot do anything. It will recur.

How do we identify the problem?

In my view, generally, apartment complexes can be ruled out as a source since there are strict compliances. So I will focus on individual home owners and any property which falls within the purview of City.

Is your area covered?

The City has posted a schedule for the area. Zip code 75063 has been sprayed on August 15, 2018. Picture below.

75063 Spray on August 15

Has the city done enough?

Please check the map for the zip code affected the intervention from the city. Zip code 75063 was treated on August 15, 2018. Please see map here.

Can we call it enough?

Obviously NO.

Why?

  1. Please ask yourself if you can play or be outside at dusk time for 10-15 minutes without a mosquito bit.
  2. It takes several rounds to kill the live mosquitoes and their larvae are in different stages of breeding. If the intervention targets all the stages, it still needs multiple rounds of sprays.
  3. Even if your area is cleared, mosquitoes from distant areas may migrate into your areas. So you have to treat multiple times.

Can we blame City?

Yes and No

Why No?

Because if we haven’t done our part, we will see a persistence of the mosquito problem.

What action is required from me as a Home Owner?

We want ALL of us to treat the problem simultaneously with same intensity. That means, even if you have no problem in your yard, we want you to treat your yard.

When?

Along with other Homeowners and the while the city is doing mosquito intervention.

What do we need from you?

This is not a mandate, a voluntary initiative. We need few folks from each lane to identify the risk for individual homes. Once identified, those homeowners should aggressively treat their yards. One treatment is not enough, multiple rounds are required.

What are the other Mosquito borne illnesses?

West Nile is not alone. The list is long –

  • Zika
  • Malaria
  • Chikunguniya
  • Equine Encephalitis (Eastern and Western)
  • Dengue
  • St. Louis Encephalitis
  • Japanese Encephalitis Virus (JEV)
  • La Crosse Encephalitis (LACV)

Do we have Zika, Malaria or Chikungunya identified in our area?

Please call City of Irving or Dallas County.

Remember, the risk is real. We all have to act now.

Read the links below for additional information.

Irving Mosquito Control Program – https://www.cityofirving.org/816/Mosquito-Control-Program)

Irving area with proven positive West Nile Virus sample – https://www.cityofirving.org/DocumentCenter/View/25998/S13—RutgersLasalle-PDF
CDC Prevent Mosquito Bites https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html

CDC Mosquito control – https://www.cdc.gov/westnile/vectorcontrol/index.html

West Nile Prevention from CDC – https://www.cdc.gov/westnile/prevention/index.html

Integrated Mosquito Management –  https://www.cdc.gov/westnile/vectorcontrol/integrated_mosquito_management.html

Zika Virus Infographics https://www.cdc.gov/zika/comm-resources/infographics.html

TOP 5 THINGS EVERYONE NEEDS TO KNOW ABOUT – ZIKA https://www.cdc.gov/zika/pdfs/Top5.pdf

 

Do we need stickers, always?

I don’t want to sound bombastic. However, when it comes to driving and being on the road, I am generally a whole lot patient simply because I don’t carry the responsibility of their risks on my shoulder. Who knows there is a baby on board, an elderly (with generally impaired reflexes) driving the car, a lady not as adroit and smart as a general driver or just the clumsiness of technology that you cannot brake adequately in time?

I have also noted that, zooming on road helps you save only 2-4 minutes of your time. If you plan and start early, you never have to vroom on the road and increase the risk (for yourself and others). Another titbit I share with my son, that if you are driving by the rule, you reduce the incidence of accident by half. The other half are still caused by others. That is the reason we should all be driving safe and not one person alone.

However, let us own up our part of responsible driving – 

  1. Driving fast only saves 2-3 minutes on a 30-40 minutes commute
  2. Starting 4 minutes ahead is truly not difficult
  3. Despite, if you are late, you won’t miss much
  4. Don’t install (police) detecting radars, getting a ticket (citation) changes our behavior. It is not a criminal offense
  5. Of course, no drinking and driving
  6. No texting while driving

We all need to practice ‘No Texting While Driving’. That isn’t’ a tall order? Sometimes, it feels as though we are asking youngsters to follow abstinence or a businessmen (and few doctors), to be puerile in their ethical practices.

Not sure if my behavior has changed anything but I have noted one thing, it made a difference to me. Being late just matters as much as being on time. I haven’t seen missing much other than being anal to be on time. It does provide me a sense of satisfaction that I am living in a macrocosm where others deserve equal respect.

I received an interesting note on What’s Up. Below is the verbatim.

A car ahead was moving like a turtle and not giving me way in spite of my continuous honking! I was on brink of losing my cool when I noticed the small sticker on the car’s rear!

“Physically challenged; please be patient.”

And that changed everything!! I immediately went calm & slowed down!! In fact I got a little protective of the car & the driver!!! I reached work a few minutes late, but it was ok! And then it struck me. Would I have been patient if there was no sticker? Why do we need stickers to be patient with people!? Will we be more patient & kind with others if people had labels pasted on their foreheads?

Labels like —

“Lost my job”
“Fighting cancer”
“Going through a bad divorce”
“Suffering Emotional abuse”
“Lost a loved one”
“Feeling worthless”
“Financially broken”….. And more like these…

Do we need sticker for the invisible ones?

Everyone is fighting a battle we know nothing about. The least we can do is be patient & kind! Let us respect the invisible labels!

Please share, it’s a matter of awareness. Somewhere, someone may find this game changer and it may change his/her driving and impact an unknown precious life, may be prevent a family from losing their beloved one.

Also visit, Speed – Bumps, Humps and Cushions on https://wp.me/p7XEWW-13T