Deterrence or Readiness?

After ruffling the feathers with its covert land grabbing intentions, China has stoked a fear unseen for several centuries in the South China Sea. The polarization against the CRIPT-K axis has galvanized truly well. This blog talks about the potential for war if it were to happen, providing the underlying dynamics and its fallouts on the outcome. (923 words, reading time 4-5 minutes).

After ruffling the feathers with its covert intentions of land grabbing, China has stoked a fear unseen for several centuries in the South China Sea. Of course, it is not just the passive land-grab, its active intrusion, and malignant interference in the internal politics to influence the decision making. The world is, of course, aware of this potent subvert development.

The CRIPT-K Axis

CRIPT-K stands for an axis formed by China, Russia, Iran, Pakistan, Turkey, and North Korea. To the disadvantage of the CRIPT-K axis (just invented this acronym while writing this blog), CRIPT-K has galvanized a congregation of forces against them. Chief amongst those are QUAD, expansion of the Five Eyes to Six Eyes. Initiation of Seven and Nive Eyes countries’ involvement reignited the ‘Durian Pact’ with potential expansion of the ‘Five Power Defense Arrangements (FPDA), into the South China Sea. Chinese moves have hastened an upgrade and build-up of arms in Taiwan, Japan, South Korea, Indonesia, Vietnam, The Philippines, Laos, Myanmar, Malaysia, and India, and Australia are already part of the Quad along with the US and Japan.

The Bamboo Diplomacy and Natuna Standoff


I have reservations about Thailand because of the ongoing strife between the king and his populace and its inclination towards ‘Bamboo Diplomacy.’ Let’s now visit the ‘Natuna Standoff.’ In Sept 2020, Chinese vessels infiltrated the exclusive economic zone of Indonesia’s fishing territories of Natuna Island. This resulted in minor skirmishes between China and Indonesia.

Bound by interests


There certainly is a weakness and potential for a few countries getting caught in the crossfire, not because they intend to participate actively. As Alexander Cooley and Daniel Nexon from the Foreign Policy write, “Even when states do not actively switch patrons, the possibility that they could provide them with greater leverage.” In a real conflict, there is a potential for these countries to not side with either of the superpowers.

Chinese incursions into the Japanese, Korean, Taiwanese, Philippine, Malaysian, Vietnamese, and Indonesian waters and air spaces is now an established pattern. With its recent adventurism from Natuna Standoff and its invasive incursions of several countries’ sovereign waters and air spaces, China has pushed these countries to drop their Bamboo diplomacy and remove their ambivalence to side with the US.

This consolidation and polarization of forces are massive polarization against CRIPT-K (China, Russia, Iran, Pakistan, Turkey, and North Korea).

Credits: https://thenewdaily.com.au/news/world/2018/02/26/south-china-sea-australia-usa/

Is war inevitable?

If I understand China, posturing is different than actually going to war. They will test the waters are keep their readiness but won’t dare to open front anywhere. If they sense a weakness in the system, they will right-away grab the opportunity. Under prevailing situations, China is unlikely to undertake any active incursions, not because it does not intend to, but because it knows its flaws and intrinsic weaknesses.

What about Russia?

Russo Putin knows his state is a declared and established pariah state. It has power but not sufficient economic might to wage war. It will provoke China, but it will take advantage of the situation to re-establish itself as one of the mainstream players in the global front-yards. There is a lack of trust between the two major players – China and Russia, to the extent that Russia did not export its S-400 latest technology to China due to the fear that China may reverse engineer and steal its secrets (Conversely, India has S-400).

The China-Pakistan Nexus

This nexus has been mushrooming due to a marriage of convenience. For China and Pakistan, India is an Achilles tendon, impeding their aspirations. Since the 1980s, China has been transferring nuclear technology to Pakistan despite being a consignee to the Missile Technology Control Regime (MTCR) guidelines and contravention of the Nuclear Suppliers Group (NSG) obligations. The world should be aware that, as recent as 2018, China also transferred, Multiple Independent Reentry Vehicles (MIRV) for Pakistan’s Ababeel and Shaheen-3. That is an imminent threat. India is on the splurge of acquiring a gamut of weapons to counter this imminent threat. 

The Appendages without independent existence

Pakistan, Iran, Turkey, and North Korea are obligate pathogens surviving at the Dragon’s cost. Without the Dragon feeding them, these are unlikely to survive and sustain, economically or politically.

What about Miscellaneous?

“Miscellaneous” groups include Sri Lanka, Cambodia, Nepal, a few South African countries, etc., who have no spine to hold themselves erect, internally or externally. Those will only serve as stations or platforms for the Chinese forces during a global fallout.

Is a war genuinely happening?

If the anti-CRIPT (K) preparedness continues, a global war is improbable to occur unless some major fault-lines resurface.

What are those fault lines? The world survived the weakness unearthed from SARS CoV2. Economic implications and ramifications are still not felt completely; we never know if other “Trumper” events are likely underway, global warming is already getting neglected. Our infamous radical terrorism has truly not reneged. These are not the fault-lines but signs and symptoms of fault lines.

Let us see how global leaders provide a direction in navigating us through these rough patches.

Thoughts, comments, please share. I wish you to be my active audience.

Shashank Heda,

Dallas, Texas

Indonesia gets US nod for F-15 and F-18 fighter jet purchases

https://asia.nikkei.com/Business/Aerospace-Defense/Indonesia-gets-US-nod-for-F-15-and-F-18-fighter-jet-purchases

https://www.foreignaffairs.com/articles/united-states/2020-06-09/how-hegemony-ends

Devoid of Credibility, Always

BRI and CPEC are already under financial and operational pressure to either scuttle or park their ongoing initiatives. India has no role to play in their self destructive implosions.

Credit: Economic Times,

None of the infrastructure development projects carried out by China in Pakistan have any Pakistani contractors. From workers, to raw material to management, everything is being by the Chinese.

Obviously, where are the resources – workers know how to run kalashnikov, banks and military knows how to make money and management has never been honed. So, it is not a wrong decision not the Pakistanis execute the blueprint of CPEC. Anyways, it doesn’t fit the Chinese model of business. Irrespective of the country where they are building infrastructure, the Chinese companies are owning those almost 100%.

Now, let’s visit CPEC dynamics

China is truly constrained on funds and revenue, for several reasons – vast infrastructure projects that have doubtful ROI in immediate future, its over 50 ghost cities, its own military and cyber incursions and now the pandemic. Keynesian principle has not stimulated the economy, not because it lost relevance, however not utilizing the principles behind the principle.

Pakistan never has a culture of entrepreneurship

Barring individual efforts, the country has never offered a milieu for growth and industry. Neither does it have the ability to repay. More-so, recently China demanded a higher interest rate. If you calculate the payback interest and principle, you will realize these CPEC are costing Pakistani Rs. 8328 per person. Agreed, not all infrastructure should be considered from the perspective of tangible ROI. We need to factor in the opportunities it creates. However, in this case where are the revenues to service the loan?

Face Saving

It is graceful to not admit any of the above but to put the usual suspect, India. Skeptics may differ but the decision is left to the future to decide.

They know this will not solve their problem but facing is an art, that conjures the present, unlikely to save from the realities and future.

Pakistan accuses India of masterminding Belt and Road attacks
https://asia.nikkei.com/Spotlight/Belt-and-Road/Pakistan-accuses-India-of-masterminding-Belt-and-Road-attacks

https://economictimes.indiatimes.com/news/international/business/china-denies-cpec-intensified-pakistans-economic-risks/articleshow/68779043.cms

A Glutted Economy

Not everything is hunky dory in China. Even if we have to consider that Corona virus is contained, the economy is definitely in shambles, and there is a reason why China portray the opposite. This article reveal the dynamics behind the hollow economic indicators. Reading time 6 to 7 minutes (word count 1150).

Ever Sold a Used Car without good cleanup?

The answer is no. Have you ever entered a showroom that makes you feel, you entered a warehouse? What if you want to sell and book more profit? Those who are in the stock market, know it well and they time the ‘sell’ when the shares are in the ascendency – a perfect time to book the best. Well, what would you do if you want the FDI to flow into your country? Showcase your country as one of the best destination to invest and do business. While countries like Singapore, Taiwan, South Korea, and Japan chose the organic route, China chose a superficial route, cleaned its car, and put it on display.

Credit: Tuomas Malinen, GNS Economics, The Stages of Collapse. https://gnseconomics.com/2020/02/10/the-stages-of-the-collapse/

A Pompous Display

Well, I have been clamoring for data on China falsifying its GDP. Let me chastise China by sharing a simile. We know of several businessmen, who display false success despite their hollowed debts. Such is the case of China – huge (and hollow) infrastructure, glass bridges spanning deep ravines, tall (empty) cities and buildings, rich (and unemployed) population, massive navy (with ramshackle primitive) ships, huge (untrained) army, and massive (captured) land like Tibet and Xinjian, poverty upliftment (despite rising inflation and unemployment) and above all, an astute (more than Mao-size) leader. You may call it billboard, attractive and intuitive enough to catch the attention and impress.

The Ghost Cities

Below excerpts from Financial Review (Citation link included in references). Even the casual observer driving around China can see that something is wrong. You can see it in the industrial parks that are empty except for a small handful of factories, and in the government buildings that are so large it seems impossible that they will ever fill in with civil servants, and in the airports that only sporadically host an arriving plane, and in the glut of exhibition centres and museums that every town seems compelled to build.

Chengong China – Abandoned Ghost Cities

Economy of Scale

The world across – businesses operate on a specified margin (percentages) and for a manufacturer, those numbers slip further but are compensated because of volume, typically called, ‘Economy of Scale’. China operates on a massive economy of scale. It has smartly created a premium segment, a medium segment, and a low-end segment. So everything sells very well.

‘Zero Waste’ Basket

Of course, the major segments are advanced economies and populated countries, but it shrewdly created multiple smaller market (segments) to sell its substandard products (the waste in a classic scenario) being pushed into these sub-optimally operating economies. Examples abound – from South East Asia, Asia, Africa to East Europe and Latin America. These smaller segments offer China a distinct advantage of recycling lesser quality to the multitude of countries in Africa and other struggling economies. Thus obliterating and reducing waste and saving further. These lower segments also provided a market (and a source of revenue) safeguards it from the whims of the leaders from these advanced economies who dictate terms to China or impose tariffs.

A Trojan Horse – The Land and the Sea Corridors

It is but natural to build a massive arborized network of road, rail, and sea lines to support its customer base and the raw material required to run its industry. Thus paving a way to the five land corridors and the South China Sea, that are central to this thoroughfare. The well known China–Pakistan Economic Corridor (CPEC), the Silk Road Railway (SRR) passing through Xinjiang, Kazakhstan, Belarus, Russia, Germany, and Poland, the China Central Asia to West Asia (CCAWA) Corridor, connecting Western China to Turkey, the New Eurasian Land Bridge, connecting Western China to Western Russia via Kazakhstan and the China Indochina Corridor, connecting Southern China to Singapore, thus establishing a conveyor belt for its State Controlled (Capitalist) the Communist Middle Kingdom. I encourage the readers to visit the link from the Council of Foreign Affairs site to see how China has gobbled up the economies of over 65 nations that have subscribed to its Land Corridors (https://www.cfr.org/article/belt-and-road-tracker)

Building Castle Cards on Keynesian Philosophy

However, BRI, CPEC, SRR, CCAWA, or the new islands or its own 50+ ghost cities – all are infrastructure projects. We all know, infrastructures are capital intensive, and consumes a lot of investments. As substantiated by John Maynard Keynes (aka Keynesian Economy), I agree that the infrastructure initiatives provide a foundation for growth. However, these are cost centers and not a profit centers and the immediate returns are negative. Thus, the only way to keep the wheels spinning is to feed this investment (mortgage) with profits from the accrued business. The key here is “PROFIT AND REVENUE”. Building infrastructure needs finance and people. State can provide finance but availability of disposable human resources indicates that people are deployable for building such massive projects, a reflection of unemployment. Thus, to keep the strife from unemployment at bay, it is best to utilize them for infrastructure construction.

Let us review such massive initiatives in the backdrop of dwindling global demand, rising middle class, and a COVID imposed lockdown. If bankruptcies are common across the globe, so are they ubiquitous in China. However, in China, the nation state funds these bankruptcies. Remember, no growing economy is spared from the ‘middle income’ trap, and China has a vast swath of population that has significantly jumped beyond poverty line to middle income. That indicates it has lost its cutting edge on small manufacturing, a competitive advantage in the past.

Revisiting the Phony Businessman

Let us revisit the phony businessman I described at the outset of this article. If you are that phony hollow bankrupt businessman, and you don’t want to declare bankruptcy, you have to display that COVID-19 is completely controlled, that the economy is not just bouncing but ‘dancing in the rain’. That’s fine for the gullible outsider, but what do we do with that internal strife?

Wars are a distraction to internal turmoil

China has no option but create a war-like situation. South China Sea Discord and The Indo-China Ladakh Skirmishes are a reflection of internal turmoil and a distraction from internal strive. Many thought Xi Jinping is opening several war fronts simultaneously. Is he stupid? No, he is not on a suicidal mission. That’s not what Sun Tzu taught him. He is a smart leader with a vision for China but he is running before he has to walk. He is too ambitious.

China is a nuclear power but not a (superior) military power, as against what it displays. History is rife and reminiscent with several examples, no one can open several war fronts simultaneously and so is true with China. Xi Jinping knows that opening multiple war theatres is a definite failure. Xi’s commitment to China is undeniable, and so the war theatrics are hollow too, especially given the sudden rise of Quad, like a Sphinx in the South China Sea. If Quad is a reality, than String of Pearls in equally an existential threat. Will that mean a war? Obviously not, China wants to intimidate but will not land itself in a war. However, the probability of war rises further, with increasing tariffs and escalation of a trade war because economy is the place where it hurts most.

Grand Deception

However, manipulating the fundamentals is a subterfuge and a grand deception for global investors. If you now recollect the example of the phony businessman, shared at the outset of this article, you will realize what I am talking about. Researchers from The Economist, Pew Research, Financial Times, or Harvard are very likely to share a similar opinion. All we have to do is keep a tight focus on fundamentals and let not China swerve us towards a ‘displayed’ billboard economy.

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Note: This is a passion and not my job, I do not advertise and collect any revenue from the visits. I attest that there are no conflict of interests or any financial gains associated with any of my blogs.

Sources:
The Economist | The real deal
https://www.economist.com/node/21792859?frsc=dg%7Ce

https://www.cfr.org/backgrounder/chinas-massive-belt-and-road-initiative

https://www.afr.com/world/asia/chinas-ghost-cities-and-their-multibilliondollar-debt-20180404-h0ybjz

https://gnseconomics.com/2020/02/10/the-stages-of-the-collapse/

Not So Confucius

South China Sea has become a bone of contention for China and other countries around South China Sea. According to Chinese Communist Party, the “One China” encompasses almost the entire South East Asia. China has territorial disputes with almost 26 countries, including Russia.

It is just not the territorial incursions, Chinese hegemony does not stop there. China has been bending democracies, not just influencing them, to align with their hegemonist interests. We all know the life of products “Made in China”, and it obstinate adherence to planned obsolescence. We, as common man, yearn for the cheap cost, of products while not realizing we end up losing in the long term. Chinese manufacturing sly is all pervasive, and has led to global erosion of value. In this article, I have captured some aspects of the recent alignments and the emergence of a theatre for the next mega war in South East Asia.

While the world is focused on Coronavirus and the US on the theatrics and tantrums, we haven’t realized that the vacuum created by the US in the last few years has resulted in a “Chinese Hegemony” and resulted in the creation of a war theatre. If WW I and II were in Europe, the future mega war will be in South East Asia.

A huge formation has erupted since the last one year, especially after the nefarious activities post the unleashing of coronavirus. Sensing the weakness in the economies and the distraction of most countries towards handling the internal health crisis, China launched massive border expansion plans across all its frontiers, almost it has disputes with 26 countries including Russia (Pakistan and North Korea are spared🤭). Of course, it has to divert the attention away from “who created the virus?” and continue on its path of imperialism, gulping the lands of the defaulters and hobnobbing and destabilizing democracies to increase its inordinate influence. I call them masters of planned obsolescence. Not shrewd or sly but cruel businessmen, with an ambition to control the world from where their ancestors left the “middle kingdom”.

The Original China – The Central Kingdom

Every ethnicity, cult, culture, and country is ambitious but when those ambitions go to the point of submissions of others. that becomes a point of inflection, the potential for exploitation. That potential was seen in the last decade when Sri Lanka lost Hambantota, Pakistan lost Gwadar, several African countries lost key strategic sites, including strategic incursions and build up next to India’s East (Bangladesh) and West Coast (Pakistan just lost 2 islands close to Gujarat).

With every Nation China has a Border Dispute

Now, the informal grouping between the US, India, Japan, and Australia is likely getting expanded to include South Korea, Indonesia, and Malaysia. Taiwan is almost an invisible epicenter. More countries playing fence seater may join, Duterte from the Philippines will have to throw in the hat.

It is important to tame these animal instincts of this dragon. Excepted, no one is sincere and dominance of one over the other creates an imbalance. However, we have to choose the lesser evil.

China’s efforts are not just to gobble up land in Ladakh or Doklam or Arunachal Pradesh.

China’s territorial incursions into India
Details of the territorial disputes with names

Taiwan, a country that is separated from China, is claimed by China as its own under its One China policy. Sometimes, I fear how our memory gives way and we selectively forget Tibet. Even Uighur was never a Chinese province. It was only in the post-WW II that they annexed it. Thus, those land grabbing tendencies are totipotent (🤣), with Chinese identity.

China, an extremely nefarious nation, has to be contained. In a world dominated by China, it’s beyond imperialism, our every human initiative will be scuttled and the state will determine the human endeavor and not vice versa. Since the last 20 years that I am learning about China, I am gradually expanding the repertoire of my understanding of their instincts, their aspirations, their vision, ideology, ethnicities, culture and language, not all of which are bad. Maybe some day, I’ll write about the good and the graceful aspects of China, a civilization that demands adoration buy one thing for sure, I will always insist, by China, I mean the Communist Party dominated the polity, that ideology has corrupted the entire milieu to a state controlled capitalism.

Need Introspection and Not a Dictate (updated Oct 26, 2020)

“In today’s world, any unilateralism, protectionism, and ideology of extreme self-interest are totally unworkable, and any blackmailing, blockades and extreme pressure are totally unworkable,” Xi said. “Any actions that focus only on oneself and any efforts to engage in hegemony and bullying will simply not work—not only will it not work, but it will be a dead end.” This applies so starkly to China, I presume, Xi echoes the sentiments of the opposite party (Newsweek https://www.newsweek.com/xi-jinping-china-ready-war-trump-biden-take-hard-line-beijing-1541606). Surprisingly that’s the ‘Art of War’, by Sun Tzu but comes under the garb of Confucius philosophy.

Credits: Atlantic Council https://www.atlanticcouncil.org/content-series/smart-partnerships/the-dangers-of-decoupling/

US vs. China: 2 leading experts fear conflict awaits
https://asia.nikkei.com/Editor-s-Picks/Interview/US-vs.-China-2-leading-experts-fear-conflict-awaits

https://en.wikipedia.org/wiki/Territorial_disputes_in_the_South_China_Sea

Am I Culpable for Spreading Virus?

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

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

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

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

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

Shashank Heda, MD
Dallas, Texas, US

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

‘Catch 22’ with COVID

Covid-19 has pushed us into a situation of ‘Catch 22’, it has exposed the fault lines on several facets on which our modern society, and especially the 21st century, are built. It has questioned the entire edifice of the foundation of humanity, especially as it exists in an integrated global dependent economy.

Covid-19 has pushed us into a situation of ‘Catch 22’, it has exposed the fault lines on several facets on which our modern society, and especially the 21st century, are built. It has questioned the entire edifice of the foundation of humanity, especially as it exists in an integrated global dependent economy.

We have polar perspectives – on one side, we have New Zealand, a small nation, that stopped everything including the virus. New Zealand is not alone state, most smaller well-managed nations were able to thwart the wave of pandemic including Romania, Japan, etc.

On the other end of the polar extreme, we have huge behemoths like the US and China, where despite the controls, the pandemic has been difficult to control.

Of course, economies suffer and to speak the ideal, mankind cannot be restricted to isolation, from itself (social network, families snd friends) and from nature. That has not been, and for millennia has never been the lifestyle irrespective of the civilization. We are definitely in a quagmire, a piquant situation of making a choice, and irrespective of the choice we opt for, we will have to pay collateral value.

That’s why I call it ‘Catch 22’, a situation that has exposed our fault lines.

Planners and politicians are facing this dilemma and resolve but none of our intelligence, native natural or artificial, will help us through this. I remember an important saying by Albert Einstein, that this problem cannot be solved with the same mindset that created it. We have to rise and evolve to a different plane to understand and solve this. (Shashank Heda, Dallas, Texas).

We cannot solve our problems with the same thinking we used when we created them.

Albert Einstein

You may well ask, is this the toughest challenge in the evolution of mankind? Well, I can say with confidence that we as mankind, have evolved through millennia and one thing is clear, this too shall pass.

Every day, I struggle to find, what’s the positive message for today. And I circle back to our inbuilt resilience. How do we strengthen and enhance, visit my next blog on road to resilience during pandemic and stress?

Disseminating COVID Expertise

We started a cross border initiative to share experience, insight, and expertise amongst those who are at the leading edge of managing COVID and those who have recently started seeing a surge in COVID cases.

COVID Rx Exchange:

It is a nonprofit & non-commercial initiative focused on the medical management of COVID patients across the globe. While those on the ground are managing COVID patients, refining, and sharing their experience with practice (guidelines), it is becoming increasingly obvious that the management of COVID needs real-time expertise sharing across political boundaries.

I am a Surgeon, do I need to be part of COVID?

Surgeons too need an understanding of primary and secondary prevention, management, and other clinical scenarios though they are not managing COVID. More so, few surgeons have accepted the mantle of driving COVID Rx Exchange as part of SOCIAL RESPONSIBILITY.

How to be part of the CovidRxExchange?

Please share your email and contact details on the below address. You may join forced discussion groups from your specialty or stay in the general pool and participate in the exchange.

Free Benefits from joining CovidRxExChange.org Slack Group –

1. Free storage of documents (word, pdf, pictures, videos audio, etc) until a limit.
2. Host meetings, audio, or video meeting. Use Zoom or other communication apps for scheduling your own (remote) consultations and exchange records/documents/reports.
3. Create theme/interest-specific groups for a focused discussion
4. Calendarize events and share invites for the meeting
5. Integrate with your Gmail account

I am confident; this will facilitate professional interaction on all medical topics. For a complete description of mission, scope, activities, and values, please visit https://wp.me/p7XEWW-1hj.

Upcoming activities:
• Managing Cardiac Complications with COVID
• Understanding Laboratory Tests for COVID Diagnosis

 

Shashank Heda, MD

Organizer, CovidRxExchange.org
CovidRxExchange@gmail.com

COVID Rx Exchange

We created this group for doctors managing COVID patients. While those on the ground are managing clinical challenges, practice guidelines are being developed, enriched, and enhanced daily. This group is focused on sharing realtime expertise across boundaries during these crises. It is nonprofit & non-commercial.

We are very optimistic about a professional discussion. Please invite your colleagues managing Covid patients. For a complete description please visit https://wp.me/p7XEWW-1hj

Welcome to all those who joined recently using the group’s invite.

We started this collaborative initiative to cross-pollinate experiences and expertise with COVID-19 across the borders. As is obvious, the EU and the US have a maximum toll from COVID-19 and obviously, the body of experience is significant. We wish to transfer the insight gained from these experiences to those where COVID is now on the rise, especially in India, South East Asia, and the Middle East.

Website Picture

Scope of this initiative:

To provide realtime information on –

1) Share actionable information to make decision making
2) Share ancillary medical information
3) Dispel myths and untrue (rumors) wandering on WhatsUp University

Activities:

  • Open and transparent real-time interaction between the members
  • Live Webinars conducted under the aegis of this podium
  • In-person interaction between experts (As far as possible)
  • Sharing of credible Webinars and Information

Accessing the archival information:

A website is being developed for uploading all this information. You will be asked to access via Facebook, Google, or LinkedIn. A link will be updated.

A key need is to have a realtime dialog with those on the ground on either side of the COVID Wave, both the receding and the rising. The intent is to share actionable and supporting ancillary information. SARS CoV2 is a new virus to humanity, is constantly mutating while humanity is unraveling the multitudes of mechanisms involved in the pathophysiology of COVID. This pandemic has driven several intelligent folks across the globe to research and refine the management guidelines regularly.

This is a non-profit, pro-bono initiative where several professionals are investing their time for humanity. We insist on using this podium to use this as an academic and non-commercial, non-promotional intent. Further, with the intent of serving humanity, this initiative is open to all ethnicities, religion, faith, or political boundaries. We ALL are committed to ethics and the highest value of service towards humanity. Last, we request you to share information that is based on scientific evidence and EBM. Professional interaction is an underpinning framework between our interactions. I am confident, you all are equally committed as I in upholding these standards.

Disclaimer:

This portal and associated applications, tools are provided as a voluntary free of charge service for the doctor and medical professionals.  The COVIDRxExchange or COVID-19RxExchange  is not responsible for the opinions and information posted on this site. The COVIDRxExchange or COVID-19RxExchange disclaims all warranties with regard to information posted on this site, whether posted by the COVIDRxExchange or COVID-19RxExchange or any third party; this disclaimer includes all implied warranties of opinion/s, insight, experience, expertise or any other implicit or explicit content for a particular use.

In no event shall the COVIDRxExchange or COVID-19RxExchange be liable for any special, indirect, or consequential damages, or any damages whatsoever resulting from loss of use, data, or profits, arising out of or in connection with the use or performance of any information posted on this site.

No content, in any form should not be construed as advice or recommendation. Doctors or Medical professional should use their judgment and expertise to make their decision while treating their patients. Those treating the patients are solely responsible for the outcome or the results. The professional opinion or expertise shared on this portal, apps, interactions, and links should be considered as the personal opinion of the practitioners. Under no circumstances, will COVIDRxExchange or COVID-19RxExchange take any responsibility for their opinion or insight, and COVIDrxExChange or COVID-19RxExchange will not be responsible for any outcome.

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​This website has select preprints or links to preprints. Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information. Using any reports, documents, guidelines, standards and best practices is the sole responsibility of the doctor/medical professional using their judgment and expertise. The information available on this portal or the links thereof, should not be regarded as conclusive, guide clinical practice/health-related behavior, or be reported in news media as established information.

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Invite to COVID Rx Exchange (below):

Covid19’s management is fast-changing and we need a realtime exchange of experience from experts to cross-pollinate those in high prevalence areas.

I am sharing the invite, please join if you are actively involved in the direct care of Covid19 patients or in a capacity to influence the care or policies. Please forward the invite to your network, especially beyond borders.

Please introduce yourself once you join.

‎Open this link to join the Cross Border Initiative to Manage Covid19 https://chat.whatsapp.com/Ghj5eKt1CoN6bsk4P2TncR

COVID – False Autopsy Report of 50 Cases

WHO has correctly warned about an Infodemic with COVID. The biggest challenge for us as the medical community is to deal with distinguishing the scientific information from the unscientific (and possibly anecdotal) information.

I read this information floating on WhatsUp University (WA Univ.) almost 5-6 days back and did not pay much credence. However, since the creation of this group, I see this for the third time. That mandates me from researching this on Pubmed Central and Google Scholar. Pubmed Central gave zero results to “COVID and Autopsy” Whereas, Google Scholar pulled few results. I have cited references along with the full text as well.

I found a total of three publications related to Autopsy. One was a single case report from China, another 12 cases from New Orleans, and the remaining report of 2 cases from Oklahoma. I searched for an autopsy study for 50 cases and I found none. Also, I saw no doctor with this background who would have not disclosed his name or published this autopsy study of 50 cases, since it would have been well acclaimed. The WA Univ. author has not discussed the autopsy finding but is driving the readers to his preset conclusions.

My Concern:

  1. If the author has truly done a study of 50 cases, why has he/she not published this?
  2. Often submissions are accepted as advanced publications subject to review, he/she could have resorted to this option?
  3. The name of the author is Dr. Fikry, a Google search does not indicate any such doctor.
  4. Why does he want to stay anonymous? Select reasons that come to my mind are – either the work cannot be substantiated or he/she has not followed the Helsinki guidelines for research.
  5. Research Style – Ideally, research has to follow a methodology, and a paper is written in order. I did not see that order but a direct jumping to evidence.
  6. Should we rely on WhatsUp University for these conclusions?

References: 

  1. Interesting read on Autopsy findings in COVID-19 from Dr. Sanjay Mukhopadhyay, Director of Pulmonary Pathology at the Cleveland Clinic. https://www.scientificamerican.com/podcast/episode/covid-19-what-the-autopsies-reveal/
  2. https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa062/5818922
  3. The above can also be accessed from https://www.unboundmedicine.com/medline/citation/32275742/COVID-19_Autopsies,_Oklahoma,_USA.

I am also including the full text of the “False Autopsy Finding of 50 cases” below along with my comments in parenthesis

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Full text of the Unsubstantiated (Possibly false) WhatsUp University version (author anonymous). 

Thanks to 50 autopsies carried out on patients who died from COVID-19, they found that it is NOT PNEUMONIA, strictly speaking, because the virus does not kill pneumocytes of its type only but uses an inflammatory storm to create an endothelial vascular thrombosis, with the corresponding diffuse thrombosis the lung is the most affected because it is the most inflamed, but also, it produces a heart attack or stroke, and many other thrombotic diseases. Infact the protocols have left the useless antiviral therapies and have concentrated on the inflammatory and anti-clotting. (Ideally, gross findings are shared substantiated by microscopic finding, not the pathophysiology or mechanism)

These therapies must be done immediately, even at home, where the treatment responds very well to the patients. Later they are less effective. In resuscitation, they are almost useless. If the Chinese had reported it, they would have invested in-home therapy, not Intensive Care! It is a case of DISSEMINATED INTRAVASCUAL COAGUALATION THROMBOSIS (see the spelling, this is typical of WhatsUp University). So, the way to combat it is with antibiotics, anti-inflammatories and anticoagulates. (Not sure if we subscribe to antibiotics in the absence of bacterial infection, a report from New Orleans emphasizes that there was no bacterial infection).

An Italian anatomical pathologist reports that the Pergamo (I never visited Italy so I searched for Pergamo, I found no Pergamo City, but one as Bergami, Milan) hospital made a total of 50 autopsies, Milan 20; the Chinese have only made 3, which seems to fully confirm the information. Success is determined by a disseminated intravascular coagulation activated by the virus, so interstitial pneumonia would have nothing to do with this, it would have been just a big diagnostic error. In retrospect, I have to rethink these chest radiographs that were discussed a month ago as interstitial pneumonia, it could actually be fully consistent with a disseminated interstitial coagulation DICA (earlier, I shared a report of the different CT findings in COVID, those images can be reviewed by clicking the links).

People go to ICUs for thrombus, generalized venous embolism; generally, lupus. If this were the case, intubations and resuscitations would be useless if thromboembolism is not resolved first. Ventilating a lung where blood does not reach is useless. In fact, nine out of ten die because the problem is cardiovascular not respiratory. It is venous micro-thrombosis and not pneumonia that determines mortality.

Why do thrombi form? Because inflammation according to the school text induces thrombosis through a complex but well-known pathophysiological mechanism. So what the scientific literature said especially from China until the middle of March was that anti-inflammatories should not be used. Now the therapy that is being used in Italy is with anti-inflammatories and antibiotics as in influenzas, and the number of hospitalized patients has been reduced. Many deaths even in their 40s had a history of fever for 10 to 15 days, which were not adequately treated here (the history is intentionally purported to mimic COVID, check the spellings, a scientific report goes through spell check, a WhatsUp University report does not) the readers to believe this is COVID-19). The inflammation destroyed everything and created the ground for the formation of thrombi, because the main problem is not the virus, but the immune reaction that destroys the cell where the virus enters. In fact, patients with rheumatoid arthritis have never been admitted to the covid departments, because they are on cortisone therapy, which is a great anti-inflammatory. That is the main reason why hospitalizations in Italy are decreasing and it is becoming a treatable disease at home. By treating it well at home, not only hospitalization is avoided but also the risk of thrombosis. It was not easy to understand, because the signs of micro-embolism have faded even in the echocardiogram.

This weekend the comparison was made of the data of 50 patients between those who breathe badly and those who do not and the situation seems very clear (Once again, to repeat, I saw no such autopsy report of 50 cases on Pubmed Central, or Google Scholar or Google, neither did I see a city by the name of Pergamo).

With this important finding, it would be possible to return to normal life and open the businesses closed by the quarantine, not immediately, but it is time to publish these data so that the health authorities of each country make their respective analysis of this information and avoid more useless deaths and the vaccine may come later.

In Italy, from today the protocols are changing. According to valuable information from Italian pathologists, ventilators and Intensive Care Units are not required. So we must rethink investments to adequately address this disease (Do we want to jump to a conclusion without sufficient evidence?).

References:

Pathological findings of COVID-19 associated with acute respiratory distress syndrome (Link here)

COVID-19 Autopsies, Oklahoma, USA (Link here)

Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans (Click here)

https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa062/5818922

https://www.unboundmedicine.com/medline/citation/32275742/COVID-19_Autopsies,_Oklahoma,_USA.

https://www.scientificamerican.com/podcast/episode/covid-19-what-the-autopsies-reveal/

 

 

 

India – A Race To The Bottom

India – A race to the bottom

CAB and NRC debate has diverted the attention away from the struggling economy. However, it is hard to reconcile arson, only if you find it difficult to torch your home just because you had to protest against your spouse. If that is scornful behavior, so are those protesters burning public property. These despicable acts can still be pardoned, with punitive damages as per the statutes.

What concerns me most is the crass abandonment of the façade of pseudo-secularism. India has for last, relegated the idea of Secularism. To talk in the US equivalent, India has indirectly modified its first amendment, a right to practice religion. More so, BJP further fractured the Seven Sisters from the North East irrationally extending the boundaries of ILP. Writing the CAB was full of logical fallacies and an act in haste.

I shared eight implications unlikely discussed by mainstream media about the current CAB. Further, I have provided evidence of a lack of humane insight with the current CAB and NRC. I am confident, you will find it insightful.

Word Count 1751, Time to Read – 8-10 minutes, Expertise – Responsible Citizen

If you are angry, do you burn your home? Arson is not justified, Period

Just imagine, your spouse is angry with you and she starts burning your home, maybe you can imagine that you are angry with your spouse, and you start burning your home. Of course, that arson is disdainful, but more than that, it is a psychopathic malady. This blog is not about how that should be treated or understanding the dynamics. A wrong remains wrong, without justification. Let us drop this British era vestige and face the truth that not just inside our home, but outside (our home) belongs to us too.

Burn It Not My Property

To be unbiased, let us not side with the aggrieved or those who are instigating aggression. Now let us watch the entire spectacle from a third person’s point of view. The first thought that comes to your mind is, ‘Is this person normal?’

Arsonists, at home or in public, are not acceptable at any cost. Protesting is absolutely a feature of any throbbing democracy but arson and anarchy justified? Protesters burn public property not because they are insane, but because they don’t consider that as their own property. If they do so, would they burn their homes too? Students have a lesson to learn from Students Emergency Action for Liberal Democracy (SEALDs), who took peaceful protest to influence the political landscape (See citations).

Drop the False Pretense 

CAB is based on a false notion held by many BJP loyalists that India is a great destination for Muslim migration from Pakistan. Statistics reveal that only Bangladesh is the country of origin for Muslim migration for India.

HL India Migration Flow

India does not appear anywhere in UN reports for migration of Pakistanis and the same holds true for Afghanistan. Barring Bangladesh, no Muslim country thinks of India as a place of destination (see UN references cited below). It is rhetoric that BJP is trying to roll out for the next election. This is quite an old strategy, ‘scare the populace and demand vote’ (read 10 stages of genocide, citation below).

Pakistani Emigration and Destinations

It is time to visit CAA/ CAB and add a missing perspective. Immigration is as old as human evolution. Like water flowing downhill, people have been migrating towards opportunities for living. Sometimes, those are plain attacks by organized armed men and often, those are innocent in search of life and better living. CAB is an intent and a sentiment converted into law. Laws are interpreted by word and provide a foundation for precedence. Once a law is created, intent and sentiments take a backstage. CAB becomes interesting from this perspective. As I read CAB, I understand it as below –

  • Hindus, Sikhs, Buddhists, Jains, Parsis, and Christians from Pakistan, Afghanistan, and Bangladesh are allowed
  • Specifically, any Muslim from the majority Muslim nations surrounding India are not allowed. However, can BJP spell out its strategy for accepting those Muslims from Enclave reassigned in 2016?
  • There is no mention about religious persecution on Muslims such as Qadian, Nizari Muslims, Hazara diaspora, Senusi Sufi’s, Ismailis and Shia’s who are also being persecuted in Pakistan
  • Muslims from The Maldives and Tibet – The Maldives is a Muslim majority nation mostly constituted from ethnic Indias from Kerala and Tamil Nadu. Similarly, several Muslims from Tibet have migrated to Kashmir or other parts of India, after the Chinese genocide and occupation. They are definitely in trouble because of CAA/CAB. Lhasa-born, Lhasa Khache Muslims and those who migrated from the central Tibetan city of Zhigatse, living in Srinagar are likely to be targeted.
  • INCLUDED RELIGIOUS GROUPS from Afghanistan, Pakistan, and Bangladesh are Hindus, Sikhs, Buddhists, Jains, Parsis, and Christians.
  • EXCLUDED RELIGIONS other than Muslims are Taoism, Baha’i, Confucianism, Judaism, Shinto, etc. It also excludes Tibetan Muslims.
  • If one sincerely intends to migrate to India from any of the above countries, CAA/CAB indirectly encourages conversion (proselytization) to any of the acceptable religion.
  • Other EXCLUDED are Agnostics, Atheist, Indigenous Faith, etc., if one interprets the law. If the law can be bypassed to get these groups to migrate to India, that’s another concern.
  • As per the wording of CAB, excluded groups from Sri Lanka, Myanmar, Bhutan and Nepal are not welcome either.

The intent is Islamophobia and though CAB abhors migration of Muslims from three countries specifically, it does not mention if Muslims from other countries are welcome. It is safe to presume, that CAB is exclusively targeted towards Muslims. Nations do not rise with a phobia, Pakistan is a good example. It cultivated hatred and diverted its resources against India and we all know where Pakistan stands today, as a nation.

Nations rise with a keen sense of identity and that cannot be a phobia toward any generic group of people. Introducing such ordinances degrades a democracy into a Taliban style model.

That does not mean, I disagree with the issues with Islam, all I insist is we need to work out a creative concrete solution and sometimes, that takes decades. There is no debate on the aggressive nature of Islam and the lack of reconciliation for the crimes committed by the bigoted and aggressive practitioners. However, that is presuming 100% of followers of Islam are bad. That also includes Abdul Kalam and several of the noble soul who contributes vigorously to the development and expansion of humane cause. Thus CAB concludes, if you are a Muslim, you need to be shunned, at least from India. In the US, they call it the first amendment. First amendment enshrines safeguarding your faith. At least, for now, India has dropped the veils and abandoned First Amendment. It is no more a secular country. Yes, India is a country for Non-Muslims though. If the US drops its First Amendment, it has dropped the very foundation stone on which it rests. India has just done that.

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The Inner Line Permit (ILP)

ILP began as a practice with British rule to keep away the mainland Indian population from gaining business opportunities into the virgin field rife with Oil, Tea and Timber business. That was more a visa equivalent, to restrict the mainlanders from the pristine North East population. It remained in place since the 1830s. Gradually, all including Assamese and Tripurites got accustomed to this visa restricted entry system since that offered protection. However, gradually the population from Bangladesh and West Bengal started migrating. However, the reaction was more towards the foreigner from Bangladesh. Not against those from West Bengal, though the pain was felt equally from the migrant population irrespective of their origin.

Assam and Seven Sisters

Thus an exercise began against the gradual migration of the Bangla population into Assam and Tripura. This migration changed the opportunities for the native population and there was an outcry for the migration to stop. The Assamese insisted on stopping the migration across from Bangladesh, irrespective of Hindu Bangladeshi or Muslim Bangladeshi. It was to safeguard their jobs, opportunities. BJP exploited this opportunity and implemented their sense of nationality at the cost of the native demand to restrict the Bangladeshi. Though it changed the demography, there never was any concern about the increasing Muslim population, except for BJP, who knew Muslims would never vote for BJP. It was an astute exercise of gerrymandering.

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Immigration and Emigration:

Like water flows downstream, so do humans migrate towards opportunities, better environment, avoid persecution, etc. Migration this exists since eternity. Birds follow this path, animals migrate towards better pastures. There is no dearth of examples irrespective of species.

No nation or geography is devoid of migrants, and always there has been a reaction of the natives to such immigration. What concerns most is not the migration or the protest against migration but the quality of protest and the dismal intention of building barriers and mechanisms for reducing the influx. Let us revisit each of these phenomena individually.

Of course, we all know people gravitate towards a better quality of life, better opportunities, avoidance of persecution, atrocities, escape torture (asylum, refugees), and hardships, etc. However, immigrants have always benefited the nation since it provides the diversity or addition of skills and labor for proper growth. Rarely people migrate because of none of these factors. Opportunities exist and so people migrate. Immigration is thus a flux or movement of people towards opportunities, whereas emigration is a movement away from their native land. We are dealing with Immigration, not Emigration. We often consider nationals of one country migrating into another as immigration. However, intra-nation migration is more common than migration between countries.

Immigration and Emigration both have consequences for the local population and the nation in general. Immigration has a direct impact on resources and revenues. Economies change drastically if there is an exodus of the working population. They leave behind an aged population and carry revenue along with them. Thus policies have to be created to control migration.

Most evolved democracies have a mature mechanism for regulating migration. However, these mechanisms are continuously monitored and tweaked, as required, to control the flow to virtuously and humanely manage the cycle of migration. An evolved democracy hardly has a religious limitation as a filter for immigrants. N400, a naturalization form that is foundational for US immigration, represents one such mechanism. Naturalization is contingent on the answers provided in this form. Any misrepresentation has the potential for revoking citizenship. Similar mechanisms can be ascertained for migrants from nations where there is a potential for social impact. Such a mechanism was distorted with gerrymandering introduced through CAB and ILP.

Conclusion:

NRC will thus be a step ahead than Watan Cards or National Identity Card of Pakistan. Let us race to the bottom along with Pakistan! If you ask me, the entire fiasco of CAB and NRC has been managed in the usual BJP style like Demonetization, Surgical Strikes, GST and now CAB/NRC.

Human Rights and Ratification

 

When most countries are accepting the Humans Rights, India is actually regressing like its Pakistani counterpart in upholding the rights of refugees. India lost its status as a secular nation, it is transitioning towards a Hindu National Identity inclusive only towards select religions. More so, the NRC and ILP have fractured the seven sisters from the North East into three categories, those having the ILP, those recently added to ILP and those tribals with a hybrid model.

Hurrah BJP! Welcome, Grand Mess!!

Citations:

Nationalism, immigration and minorities

1. Nationalism, immigration and minorities

Explained: Where the Citizenship (Amendment) Bill does not apply

https://data.worldbank.org/indicator/SM.POP.NETM

Click to access MigrationReport2017_Highlights.pdf

Click to access MigrationReport2017_Highlights.pdf

Overseas Pakistan https://en.wikipedia.org/wiki/Overseas_Pakistani

Pakistan as a Return Migration Destination
https://www.prio.org/Publications/Publication/?x=8743

Explained: Where the Citizenship (Amendment) Bill does not apply

https://slate.com/news-and-politics/2019/12/citizenship-bill-modi-protests-india.amp

https://www.pri.org/stories/2019-12-16/india-citizenship-law-protests-spread-across-campuses

Students Emergency Action for Liberal Democracy (SEALDs), https://metropolisjapan.com/sealds-legacy/

10 stages of genocide. Where does India stand? #CAB https://www.reddit.com/r/india/comments/e8du1h/10_stages_of_genocide_where_does_india_stand_cab/

https://idsa.in/system/files/monograph/monograph56.pdf (Illegal Migration From Bangladesh).

Migration of Enclave dwellers – India and Bangladesh Swap Territory, Citizens in Landmark Enclave Exchange https://www.migrationpolicy.org/article/india-and-bangladesh-swap-territory-citizens-landmark-enclave-exchange

https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199935420.001.0001/oxfordhb-9780199935420-e-7 (Lhasa Tibetan Muslims)

https://timesofindia.indiatimes.com/india/what-is-citizenship-amendment-bill-all-you-need-to-know-about-cab-bill-2019/articleshow/72449945.cms
https://www.hoover.org/research/how-should-we-value-immigrants-and-how-should-affect-immigration-reform