CovidRxExchange – A year into the Journey

As I take this moment to recap our one year journey with CovidRxExchange, with all humility I wish to honor and pay our gratitude to our Patrons, Mentors and SPOCs, Executive and our various teams who helped evolve CovidRxExchange as an initiative to reckon with –

Patrons –

Dr. Vikas Mahatme, Ophthalmologist, Padmashree, and Rajya Sabha Member
Dr. Sunil Deshmukh, Radiologist and Former, Minister, Govt. of Maharashtra.
Wing Commander Babu, Formerly IAF
Mr. I. S. Chahal, Commissioner, Mumbai
Dr. Zodpey, VP, PHFI, Delhi,

Mentors:

We are deeply humbled and honored to have mentors like –
Prof. Emeritus Dr. Manbar Rawat, a Prof. of great respect and repute across multiple generations.
Prof. Emeritus Dr. Vilas Jahagirdhar, Formerly, Prof Microbiology and Dean
Prof. Uday Bodhankar, Formerly, IAP President, VP COMHAD, UK
Prof. Vrinda Sahasrabhojaney, Retd. Prof. Medicine.
Dr. Naveen Thacker, Director, IAP

Intent and Objective:

CovidRxExchange, a global nonprofit initiative, started in March 2020 to disseminate expertise, insight, and experience in managing Covid for the doctors, Health Care policymakers, and policy planners, and administrators. The intent is to enable doctors across borders to leverage the expertise they have honed in Covid patients’ care.

In March 2020 (exactly a year back), our initial foray was to disseminate knowledge and expertise from the US to the experts at Mumbai. We arranged our first call between Dr. Toraskar, Chief of Critical Care at Wockhardt and HOD of Cardiology at Nair Hospital, and two experts from the US, who had by then gained significant experience managing critical cases of Covid. From that experience, we realized, it is best to institutionalize the knowledge transfer and make it global. After that, we started panel discussions on the practical care of Covid in HDU and ICU.

Over a period of time, as Covid kept raging across countries, economies, globally, nationally, and regionally, we realized the needs got more specific, and we differentiated our nonprofit services to include more services under our gamut of CovidRxExchange.

Scope and Out of Scope: We are aggregators and disseminators of expertise, insight, and experience. We occasionally conduct our own research. We are a global organization.

Our Ethical Values

CovidRxExchange adheres to strict ethical guidelines. Nondiscrimination and noncommercial form the backbone of our services. We are an inclusive organization devoid of leaning towards any political ideology or any faith-based ideology. We are committed to translating academic evidence-based medicine to enable doctors, policymakers, and administrators. We are noncommercial and agnostic of vendor bais in providing our nonprofit services.

Activities and Accomplishments:

A. Our Initial Engagement – Panel Discussions and Second Consultations

After conducting several panel discussions, we were approached for several second consultations. Our next group was the second consult, and our global group of experts offered a second consult in several cases. Dr. Ajay Chaurasia (Cardiology, HOD, Nair Hospital), Dr. Nandita Divekar (UK), Dr. Rahul Sarkar (UK), Dr. Hettiarchi (UK) and Dr. Sandip Banerjee (UK),

B. Web-based Knowledge Repository (Lifecycle and Extended Lifecycle Approach)

Eventually, we created a web-based repository, a library with a Lifecycle approach to deal with Covid. Our lifecycle approach provides end-to-end case expertise of different aspects of covid from remote consult, first visit, admission (floor) to HDU, ICU, discharge, and bereavement.

As Long Haul disease became prevalent, we extended our Lifecycle Model to Extended Lifecycle Model, including Stress Management for Doctors and HCW and rehabilitation.

C. Risk Management: Extending Individual Care to Institutions, Cities, and Corporations.

Realizing that Covid was no more a patient condition, we created a 3×3 model. The 3×3 model extended the services to institutions, cities, and corporations. Thus the policy planners too came under the aegis of Covid Care. We helped the City of Coimbatore, An City (Anonymous) with significant Covid to identify and restructure their Covid, and did a post facto analysis for a metropolitan area for What best could have been done. Indore team (comprising of Dr. Nishant Khare, Dr. Sanjay Dhanuka, Dr. Anand Sanghi, and Dr. Gaurav Gupta), the UK Team (comprising of Dr. Divekar, Dr. Banerjee, Dr. Sarkar), the US Team (comprising of Dr. Lakshimi Sambathkumar, Dr. Arvind Virmani and I), and the Mumbai Team (comprising of Dr. Chaurasia, Dr. Ashok Anand, Dr. Hemant Bhandari, and Dr. Pankaj Maheshwari), worked along with the Coimbatore Commissioner, Deans, and Professors to provide a blueprint for Covid mitigation in the Corporation of Coimbatore. Dr. Rajamani and Ms. Kruthka Govindarajalu, Director, Smart City, Coimbatore, played a pivotal role.

D. Tribals and Areas of Deprived Resources: Eventually, as Covid made inroads into the tribal areas/interiors and understanding that 10% of India’s population lives in Tribal Areas, we developed our Tribal Covid Model. Dr. Ashish Satav, Dr. Sahasrabhojaney, Amod, and I, spearheaded this Tribal Covid Model. Realizing that the economically deprived areas and tribals areas have shared problems, we consolidated this capability under Tribal and Areas of Deprived Resources.

E. Holistic Health: Mindfulness, Sleep, Exercise, Nutrition, and Yoga, are crucial to achieving normal health. Ms. Gomathy Periatheruvadi, an Entrepreneur and Executive from the US, is leading this capability.

F. Rehabilitation and Long Haul: This is one area where we are still striving to expand our footprint. We are exploring to develop this capability, and Dr. Mariya Jiandani has shown interest and bandwidth to expand these services.

G. Vaccines – Developing a requisite immunity is based on critical success with Vaccine deployment. Vaccines emerged as a significant area that our doctors needed an incredible amount of support. Realizing this, we organized a series of panel discussions and one on one calls to address patient concerns.

H. Variants – Mutations and their aggregation into variants created a different challenge, both in transmission, infectivity, and the second/third/fourth surge across nations. We have set up a dedicated capability and integrated this under the vaccine capability. We are exploring the implications of the variants such as B1.1.7, B1.351, P.1, B1.521, and the recent variants found in India and other countries on the transmission, infectivity, morbidity, and mortality. Dr. Mukul Acharya (UK), Dr. Anand Kawade (India), Dr. Nitin Wairagkar (US), Dr. Kedar Toraskar (Mumbai), Dr. Naveen Thacker (India), Dr. Suhasini Balasubramiam (Chennai), Dr. Anita Mathew (Mumbai), Dr. Mala Kaneria (Mumbai), and Dr. Neetu Jain (Delhi) are working under the mentorship of Prof. Dr. Rawat and Prof. Jahagirdhar.

I. Dispelling Rumors: As rumors are flying rife; we are identifying SPOC’s to evaluate, analyze, and provide a scientific evidence-based rationale to dispel rumors

J. Socialization of scientific understanding into commonly understood language is important as we consider that if our nonmedical community is aware, they can be the necessary pivot to transgressing towards success. Thus dispelling ‘Rumors and Socialization’ are emerging as recent capabilities.

K. Liaison: Covid needs an adequate translation to policy and execution. We are currently working on establishing a capability to connect with the policymakers at different Govt. Machinery levels.

L. Awareness: Specifically for the nonmedical folks based in the US, we have created an Awareness Group to share information on awareness.

M. Strategy, Risk and Program: With my background in Strategy, Governance, and Risk Management made me realize that these should include these as independent capabilities. Thus, Strategy (Wing Commander Babu and I), Governance (Founders) and Risk (Amod and I) are maturing this capability. We reinvented the industry approach on Risk Management and tweaked it to align with Covid and Medical care. Concurrently, as capabilities were sprawling, we realized a common framework should encapsulate the entire initiative. Thus, we initiated program management (with a CMMI/ISO) capability to standardize for all the capabilities. Manish Singhal has taken the onus to develop this nascent capability.

N. Legal, Compliance, Finance: While some of these capabilities are a doctor (customer) facing, many capabilities are operational and happening on the backend: operations, Legal, Compliance, and Finance capabilities. Mr. Yogesh Vyas, Mr. Amod Manjrekar, and

O. Technology: Manish Singhal, Amod Manjrekar, Pankaj Bhakta, and Shriram Devata provide that support. This is still an incipient and nascent capability where we are expecting significant development.

P. CME: These capabilities are in embryonic stages. We are exploring global sponsors and accreditation for this capability.

Q. Editorial: We are upgrading our capability to provide updates (weekly, daily, and flash). Currently, we are scaling capability to include over 2000 of our users.

R. Emerging Technology: We are building an industry consortium to address medical problems leveraging technological advances. An example can be using Artificial Intelligence and Machine Learning to address predicting the utilization of beds, or developing a model to understand the emergence of a specific variant in a specific geography and the impact of these newer (hypothetical) variants on transmission, infectivity, and overall community-based impact.

S. Ombudsman:

We strongly encourage professional interaction and courtesies. We heavily lean on Evidence-based rationale, and we respect creativity. Our ethical values are foremost essential for us, and we cherish those with the highest order. We have identified Prof. Emeritus Dr. Manbar Rawat to resolve any residual issues if not resolved by the Founder.

All along, we have ensured that only hands-on experts are providing the knowledge transfer. We are not book-based academicians. Our experts have significant hands-on experience and expertise from their specialized domain. These experts’ work contributions are pro-bono, i.e., they do not charge us, and we do not reimburse them.

Funding: As of this writing, we the Founders, have funded all the initiatives. We have not received any funding from donations, advertisements, any pharmaceuticals, or any other industry. We have avoided all and any conflict of interest.

Scaling and Continuity: We will explore submission to foundations for support. If we secure funds for CovidRxExchange, we will announce that and develop Policies, Governance, Visibility, Transparency, and Audit/Accountability.

Slack: Slack is our global portal of Collaboration and Communication. However, WhatsUp is a transitory and stop-gap arrangement to support ease of communication.

Movers and Shakers: We will post the list of Several Movers and Shakers who make this initiative a throbbing success. Women, Budding Leaders, Technology Team and Operations team are few who make several things happen.

Our Founders (in alphabetical order of their first name):

Dr. Ajay Chaurasia, HOD Cardiology, Nair Hospital, Saifee Hospital, Mumbai Hospital, etc.
Dr. Anand Kawade, Pediatrician and Vaccine Authority, KEM Hospital, Pune and Vadu
Dr. Arvind Virmani, Molecular Scientist, Washinton DC.
Dr. Ashok Anand, Professor and Head, Gynecology and Obstetrics, GMC and JJ, Mumbai
Dr. Hemant Bhandari, Orthopedician, Mumbai Hospital, Mumbai
Dr. Pankaj Maheshwari, Chief of Urology, Fortis Hospital, Thane, Mumbai
Dr. Shashank Heda, Molecular Pathology and Technology Executive, North America

Humble Note: If inadvertently, we have missed a name, kindly bring it to our notice and we will credit them for their contribution. We request you to pardon for any of our omissions.

Trusting the Dragon Buddha

First, let us understand why not to believe the recent spurge in Pakistan’s peace initiative to India. Next, let us understand the Chinese conditional regression from Ladhak, and then, we know the Salami slicing in the South China Sea and the East China Sea.

Pakistan Initiated India Peace Process

After bitterly fighting with India from 1948 until 2020, Pakistan has a ‘sudden realization’ of having peace with India. Imagine a country (Pakistan) that divested all its resources to make its citizens impoverished and deprived of any moral or intellectual standing in the global polity of ideology and leadership. It is an established fact that Pakistan is the global cauldron and mother of all radical extremism and home for terrorism. Hegemony is within the moral code of Pakistan, to the point that it did not let the elected rulers from East Pakistan rule the country, thus dismembering its sovereign part. It is no secret that Pakistan acts as a vassal state embracing economic imperialism from China and economic dependency on other robust nations. Of course, it has fought a long war of 70 plus years with India, bringing the entire country to bankruptcy, chaos, and total failure. Can you imagine for what? Well, some amongst you may be thinking it is Muslim brotherhood, others may be thinking Kashmir. Well, you may be correct, but I will be tempted to think of ‘hegemony over India’ and what India stands for. Such is perfidy that builds their moral compass. In cell biology, apoptosis is defined as programmed cell death, where a cell kills itself as it gets old or becomes sick. In the case of Pakistan, it is auto-nemesis, or killing oneself with absolute (and obsolete) jealous ideology.

For India, peace is the definite objective, but do you believe a nation like Pakistan has a sudden change of heart for no reason? At least, I won’t? However, the vagaries of politics are different. I can understand the dilemma of Modi, especially when the global thought leadership insists on negotiating peace (not war). It is difficult to reject instead then embrace such a peace offer, thus the white feather from both sides.

Ladhak – Chinese Conditional Withdrawal

What is in a withdrawal when you are an aggressor? And imagine you put conditions on retreat. Imagine the audacity in such graceful withdrawal and now imagine India’s declaration of ignominious success and boasting of success by the Modi government, especially after the sudden attack on the power grid in Mumbai? Yes, we can count success as requesting intruders to vacate our land, or you can claim you drove them out by ignoring the conditional aspect. Why not?

The above are all Salami Slicing that you all are aware of. Salami Slicing is cutting slices or loaves from a piece of meat (to those naive readers). Does it sound familiar? You can be innocent and believe Pakistan and China, sing eons in praise of peace negotiators, or be prudent and plan your strategy.

Having provided a background to the Dragon Buddha, let me share additional strategies from CCP.

First Island Chain

Well, those deeply immersed in their own problems have little insight on what the first Island Chain means or the implications of losing those until it hits your kitchen and daily life.

There is a significant existential threat to your kitchen getting costly or your daily life getting disrupted with China gaining supremacy in the South China Sea and strangulating the shipping lanes to its own benefits. I will talk more about those implications in a later blog. However, let us turn towards the First Island Chain. Immediately beyond the Chinese international waters lies a chain of islands that belong to several independent nation-states from Brunei, the Philippines, Malaysia, Vietnam, Indonesia, Japan, and South Korea.

Diaoyu Islands and the East China Sea

Senkaku island belongs to Japan. China calls it part of their own territory and is referred to as the Diaoyu islands. The name is apt, “Do I Owe You?” ( 😀 I just coined it). I still have to research what they call in Mandarin, “Mine is mine, but yours is negotiable”. Fun apart, but that can be the mandarine name for almost all the disputed land, water, and sea territories presumed to belong to China.

Fun apart, let us see what else is at stake. Territorial aggression occurred when China stationed its Naval Carrier between Okinawa and Miyakojima, cutting off Japanese sovereign islands from the mother island. According to Toshiyuki Ito, professor at Kanazawa Institute of Technology and a retired vice admiral at Japan’s Maritime Self-Defense Force, “the area was temporarily subject to a situation where it was placed under the influence of a Chinese carrier.”

However, this indeed played well in upping the Aegis Air Defense Missile System between Japan and the US Aegis Air Defense would have died a natural death had it not been for the transient territorial aggression. It only proved proof of concept (POC) and why Air Defense is essential and critical.

Spratley and Paracel Islands

Picture Credit – Voice of Djibouti.com

It is no secret that China has developed complete control over these islands. You may be wondering, are these the only islands that these entire war regimes are likely to be fought? Let us add a few more like the Fiery Cross Reef, Subi Reef, and Mischief Reef are naval harbors with full Chinese Military encampment with fighter jets, bombers, and missiles.

War, not War Games
Traditional wars were fought with large drives of armies and big air or naval attacks. The last one was the theatres in the second Gulf War when Saddam was caught hiding in a drain pipe. Gone are those days if you are presuming wars would be theatres.

Current wars are Salami.

Besides, China has adopted the anti-access/area-denial strategy to keep out US aircraft carriers if conflict breaks out in Taiwan or the South China Sea.

Initially, current wars are small wins, followed by large sudden disseminating forces. These small wins are the so-called Salami Slicing, a type of guerrilla war. Temporary aggression and Anti access and area denial are just the probe games. Similarly, cyberwars and crimes, election interferences are transient strategies. The real war strategy and the actual war will be different. You may awaken a fine morning to see a significant truce that has turned the world upside down, do not be surprised.

The Xi within Me!

What would I do if I were President Xi Jinping? I would never fight a multi-border, multi-country war concurrently. I will identify my top priority, gain significant wins, and then charge lesser states. What is wrong if I make small wins against smaller states and keep the significant war at the end?

The End Game

Why not win with a thud rather than start with a boom? A right question, However, imagine if I am pushed back in Doklam, Bhutan, or Ladhak – I lose grace and edge over moral leadership supremacy. Of course, the Chinese army is hollow, but how do you win a war with a hollowed-out (gun) barrel? Never fight a real battle but use war strategies. Intimidation is a crucial pawn that, if knocked down, takes away many strategies.

So, what matters most to Xi at this moment is intimidation and domination, not over a small region like Doklam or Ladhak but the South China Sea.

Gaining control over the international waters responsible for 60% of global transit provides a choke point; not even a big container ship that got stuck in the Suez Canal would do.

Just imagine, China wins the war and imposes an extra 1% tariff on all the goods passing through these waters as one of the preconditions to a truce? If you bump up those numbers to 5, it would be a downstream avalanche. Now, imagine the impact on your kitchen, your daily dinner plate, and your daily living. Imagine, the most affected are the lower strata, which would catapult a revolt. How would any country contain an internal revolution? Well, keep them happy by sharing largesse.

Where is the largesse?

Rich will always get richer; that’s the history of good times as well as the pandemic and downtimes. Imposing any additional tax or burden will not cause any impact on life or living. It is the middle class who would bear the burden of this crisis.

Now, let us turn towards Ladhak and Doklam. Let us activate a two-front war with India. Isn’t it easy to win?

Do you trust Pakistan or China again?

Shashank Heda
Dallas, Texas

https://www.stimson.org/

Capitalist Democracy caves into State Controlled Capitalism

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

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

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

The west willfully ignored Tibet.

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

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

Territorialism is not wrong

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

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

B. Rise of a Demon (dragon)

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

C. Wars live lopsided losers

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

D. Planned obsolescence

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

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

E. Free Trade and WTO

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

F. Lip service

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

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

Shashank Heda
Dallas, Texas

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

Not farther from the truth

Why I don’t believe Chinese Research

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

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

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

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

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

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

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

Shashank Heda
Dallas, Texas

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

The case of a swollen node?

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

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

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

Illustration Credits, Wiseegeek

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

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

Why does it matter? 

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

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

Illustration credits: WebMD

Learning lesson: 

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

Commonly used terms in the illustration below

Illustration Credits: Medicine Net Inc.

Shashank Heda, MD

Founder and Chief Executive

CovidRxExchange 

Email: info@covidrxexchange.org

Phone: +1 (650) 996 6745

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

Mapping The Minefields – 1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Manage COVID After A Recess

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

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

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

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

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

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

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

So, what do we do next?

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

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

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

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

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

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

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

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

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

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

Let us understand those and tailor our activities.

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

Links to the blogs below –

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

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

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

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

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

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

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

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.

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.

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

Evangelizing Vaccination

If only we proactively spread the message within our network, engage in an active dialog, resolve the misgivings around the vaccine, start Fastrack the process to curtail the virus. Our ability to bounce back, as a nation and as a community, depends upon how we counter the virus.

The UK is now reeling under one of the most severe public health crisis, not seen since the start of the current pandemic. Despite adequate care, few variants are loose in the community with a propensity for increased transmission, ability to evade the RT PCR tests, cause severe disease and a potential for decreased vaccine efficacy. The later is still under review, while the available data is indicating that the efficacy is probably not compromised.

On Dec 26, 2020, I shared a link associating the variants with the infectivity, implications on testing, therapy, and vaccines. https://mymilieu.org/2020/12/26/emergent-variants-and-infectivity/ Now, these variants are gradually becoming pervasive. In the UK, the lockdown has become commonplace. LA is Southern California, is no exception.

Credit: New York Times, https://www.nytimes.com/interactive/2021/health/coronavirus-mutations-B117-variant.html

As the mutant variants in fast-moving across communities, they will strengthen by our resistance to vaccinate. I shared another link, https://mymilieu.org/2021/01/28/a-triple-whammy-variant-vaccination-and-complacency/, that provides a simple explanation on how vaccination will halt the spread of the virus. The medical community and other healthcare workers have to put all their might to counter the anti-science (believes) and the rumors generated from conspiracy theories to increase adoption of the virus. However, the responsibility falls on all the elites, not just those from medicine and allied faculty, to spread vaccination.

If only we proactively spread the message within our network, engage in an active dialog, resolve the misgivings around the vaccine, start Fastrack the process to curtail the virus. Our ability to bounce back, as a nation and as a community, depends upon how we counter the virus.