COVID-19 is available for pre-order

This book is now slated to be available on August 25, 2020. The final processes of editing and formatting will be completed by them.

It is now available for pre order.

The purpose of publishing this book is to share simple knowledge on COVID-19 that would be understood by the ordinary lay public.

Therefore I would like to see this widely disseminated. As soon as it is formally released, then I would make it available for free download from Amazon.com.

So, I do not expect friendS and relatives who are in my contact list who receive these messages to pre order.

They would definitely get the information for the free download.

Please feel free to share With others who might benefit from this.

It is available For Pre-order in Amazon.com as COVID-19, Rajaratnam Abel.

Thanks.

Rajaratnam Abel

COVID-19 My newest e book


I thank God for giving me the opportunity to presnt my next book. It has taken me much longer than I imagined and planned.

This delay in finalising this book has also meant that, the blogs I used to write were also delayed much longer than I had anticipated.

Once the book is released, you can expect the blogging to restart sharing valuable experiences and lessons learnt.

This e-book has been written primarily for non-medical personnel. This includes the general lay public as well as development staff of NGOs and other organisations involved in educating the community.

Some medical personnel might also benefit from some of the information contained in this e-book.

While it is planned to be made available online through Amazon.com, I would explore every possible avenue of making this available at no cost. This is to help people prevent themselves from this deadly disease.

I will get back through this blog once the e-book is released.

Rajaratnam Abel

Countries with Different Economies and some Covid indicators

I came across this set of graphs of countries with different economies and covid indicators. I am thankful to Dr Sandhya Ahuja for presenting such valuable information graphically. I can imagine the amount of time it would have taken.

I thought some who are analytically minded would like to delve deeper into this set of graphs. Anyway, I have some questions below which might stimulate your thinking.

https://www.worldometers.info/coronavirus/?nsukey=DwA4%2FRBtAwsUGls3CE%2F6svxGi81XVxq35nyfIcFfiMxBucPQEpJhc0kDrCnKRWTL%2FU%2BK%2BE8IsjhM6C1ATMNwdPCny2JmeMR20RFbV%2BGrOEMitbh%2BwQEFnl%2Fxh%2FIKZ7ZJI%2B5TPLzgDvAxcEBxPFKyIZ6sFEWFjLFK2wqsiik4zm0jYD9cbLi91wlAB2Lrzmfe%2BvUTWSpTaL52Tt4BFT2bxg%3D%3D

  1. Why is India’s position so surprisingly different?

2. Do these indicators indicators something more serious?

3. Is India on the way to losing its game based on the actual situation in the ground?

Enjoy the graphs and would value your comments.

Rajaratnam Abel

Migrant Labour: Hidden Powerhouse of the Indian Economy

Over a month ago when Tamilnadu state and India as a nation announced lock down, there was a subtle difference. Tamilnadu gave 36 hours for the people to adapt to the new social norm. India gave 6 hours to its citizens to adjust to the change.

The implementation was needed, but not the suddenness and the surprise element. It was assumed that it was not adequately planned to meet the needs of its citizens. The plight of the migrant labour has clearly indicated the poor planning.

Probably no one realised the actual numbers and the depth of the involvement of the migrant labour in the Indian economy. All the gains of the initial efforts at controlling COVID-19 in India, could be lost for not making adequate plans for the migrant labour.

Tamilnadu, on its part took some initiative in taking care of the migrant labour in the state. But as the lock down extended, other interventions had to be made on their behalf.

Only when migrants started walking long distances to reach their original homes, did the authorities wake up to the reality of the problems of the migrant labour. The accidental deaths of a sizeable number during the journey increased additional concerns to the problems they faced.

A little effort at coordinating government initiatives Both central and state governments and the support of the corporates who had used them could have prevented this hardship.

I attempted to get some links oand pictures depicting some of the stark realities of their long walk home. These are to have a glimpse of the problems they faced.

https://www.ndtv.com/india-news/coronavirus-lockdown-desperate-to-go-home-migrants-swarm-ground-near-delhi-for-buses-2230816

https://www.ndtv.com/india-news/coronavirus-lockdown-migrant-who-wanted-to-see-dying-son-finally-reaches-home-in-bihar-2231010

@arvindcTOI

What made these migrants choose to walk long distances. With no jobs, no wages and no food, they felt they were left with no option but to take resins in getting back to their own villages. This was predicted about lock downs, when implemented without proper planning, anticipating the needs of various sections of the population. The migrant labour were not on the radar of the planners, while planning work from home and stopping all Form of labour.

This blog is not to highlight the failure of planning but for the need to plan for the future. Sooner or later, these migrants who walked or traveled on different forms of transport back home, these same migrants will have to be brought back for the resilience needed for the economy.

Systematic plans must be made for identifying strategies to bring back for the work the migrant workers have been carrying out For the development of the country and its economy.

May be this is the time to organise the migrant labour systems. The states and the centre should devise ways in which the various needs are met.

At present there are contractors who bring in these migrants. The problems faced by the migrants have not been adequately addressed.

Near my home, there is one Odisha Bhavan and another Assam Bhavan. These and similar set up by other states should take the initiative to provide support to migrant labour.

There are problems created by some of the migrant s and or their representatives, which end to be addressed as well.

The role and responsibilities of the corporate and private sector in employing migrant labour should also be clearly defined.

The plight faced by the migrant labour have been indelibly etched in the minds of the people. Fortunately, individuals and organisations with a service mind pitched in and helped the walking migrants as much as possible.

Some gave money and helped them. One traveler reported as he went in his car from the south to the north, that all along the route there were people who were providing food and water to these weary travellers. One set of individuals coordinated with the governments of the sending and receiving states to smoothen the travel process when train services were made available.

You can add your thoughts to these as the government comes to grips with the plight of the migrant labour in the country even as they realise the tremendous contributions to the economic development of the country.

Dr John Scudder II The earliest volunteer for vaccine trial

Recently there was praise showered on two doctors in the UK who had volunteered to take the first shots of the vaccine developed for COVID-19 disease. More than a century earlier, there was another medical missionary, who submitted himself as the first volunteer to test a vaccine that was prepared then. It was none other than Dr John Scudder, the father of Dr Ida S Scudder and the son of Dr John Scudder Sr. 

This vaccine was developed by Waldemar Mordecai Wolff Haffkine. He was a Russian Jew, who was called from Paris to Bombay, to work on a cholera vaccine. When he arrived, he observed that there was a plague epidemic that needed immediate attention.

Recognising that many Indians would reject vaccines made of animal tissues, he devised a culture medium made of ghee or clarified butter used by most Indians.

Three drops of these cultures were strong enough to kill the most powerful rodents but when destroyed by adding carbolic or mustard, they were harmless to animals. However, they still possessed the power to stimulate a person’s immunity against plague.

To persuade the the local Indian population to have the vaccine, it was felt that the missionaries must be the first volunteers. Dr John Scudder agreed to be the first volunteer. At his request the Surgeon General Bannerman not only provided the vaccine, but personally came over to give the first vaccine.

The first vaccine was injected into Dr Scudder’s arm as he rolled up his sleeve. Then Mrs John followed. Then others who witnessed this mainly Europeans followed. When word spread that Dr and Mrs John had received the vaccine, many Indians from the Kodaikanal area came and received the vaccine.

Unfortunately, of all the people, Dr Scudder reacted badly. It was not clear whether it was heat boils of the hot summer or a reaction to the vaccine itself. These boils never healed even when he stayed in the cool climate of Kodaikanal. Two of the best doctors of India were in Kodaikanal at that time. They agreed to operate on him.

The surgery was done in the open verandah of the Scudder home. Young Ida and her brother Walter were the ones who did the sterilising. Large kettles were used for boiling the sheets. Then they were dried in their oven.

When they opened, the surgeons found a very extensive cancer which they were not able to remove as the patient was sinking  rapidly. They sewed up the wound.

As he regained consciousness, he uttered the words, “Oh Jesus, let the light go out.” Once he lost his consciousness, he was taken to be with his father in heaven. Dr Wykoff, one of the missionaries working at that time paid this rich tribute. 

“A great missionary’s has fallen. I use the words in their fullest sense, without any qualifications or reserve. In quiet steady devotion to daily work, in wise judgment in mission affairs, in evangelistic fervor and pastoral faithfulness, in short in all that makes a successful missionary, none have surpassed and few have equalled him.

His greatest fault, if it can be called such, was self depreciation. Only those who have seen him at his daily task in India and witnessed his dogged perseverance and his unwearied diligence, in spite of heat and sickness and hundreds of other trials, can appreciate the abundant service that this man of god did for his Master.”

Not only has Dr Ida Scudder’s success with CMC Vellore completely eclipsed  and overshadowed the work of her grandfather but of her own father as well. I had read this before, but had not included in my first manuscript.

When I read about modern volunteers, I went back to the almost ready for publishing manuscript and added this story. This is the simplest that I could do to recognise this great man of God who carried forward the legacy of his own father.

God willing, the biography of Dr John Scudder, the world’s first medical missionary is ready to be published soon. This story finds a place in that book.

Soon, I’ll share more details about this and other books likely to come out from Abel’s stable the Creative Abel.

Rajaratnam Abel

COVID 19-Past Present and the Future Focus on the poor

This was not what I had in mind to write this time. With the whole world focused on this disease, I thought of sharing my thoughts on this disease.

This disease has caught the whole world by surprise. Economic plans, travel plans, marriage plans, educational plans have all gone awry. The pace at which it started in China and then Iran and Europe and finally the US is unthinkable. Who expected the US to wilt under this virus so badly with no control whatsoever?

I really do not have to say much about the past. You have all been fed with up to date information regarding how and where it all started. Interestingly one of my classmates shared the information from a novel written about forty years ago.

It is entitled, ‘The Eyes of Darkness’ written by Dean Koontz. The description is precisely close to what actually happened. Wuhan is mentioned in the story. Did someone actually follow upon the novel? I’ll leave it there about the past.

The present is filled with uncertainty. Never have we seen all trains cancelled in India for five weeks running. In the past, even with the most major natural calamities, the Indian Railways would always have earmarked trains that connected the major cities.

Once I traveled from Kolkata to Chennai through Tatanagar, Nagpur, Guntakal and Arakonam due to severe floods in Andhra. This was the only train that operated that day.

We have heard of lockouts but never a lock down. Major parts of the world are under lock down. You know the frightening numbers of infected and the deaths. They need no repeating.

It has changed our human behavior. This evening I behaved in the most un-Indian manner. A neighbor came to pick up something. I made him stand outside and talked and gave him the materials without allowing him to come inside.

It is the future that is important. How will we face the future? First of all, I would like to look at what has been predicted as the likely and potential scenario emerging from the aftermath of this disease.

Recently in a prayer meeting one of the speakers mentioned a few of the different after effects of this pandemic, as points for prayer.  As you read you may feel that it requires no super knowledge. 

  1. Economic effects on the poor. The harsh realities of the effect on the economy are clear. But how would the poor especially the migrants manage?
  2. Bio terrorism. Terrorist would find this a valuable weapon in their warfare.
  3. Psychological and mental issues
  4. Loneliness during lock down
  5. Army could be brought in if uncontrollable
  6. More deaths – orphans and the vulnerable would increase- as with HIV/AIDS
  7. Wars could erupt

Of all these, my concern and focus is on the poor in every country. As millions have lost jobs, even if the economy starts returning to normalcy the poor are going to find it difficult to get back their jobs reasonably fast.

Those whom God has blessed with sufficient resources should identify ways in which they could help the poor in their vicinity and neighborhood, either individually or through organised groups and associations.

Food and livelihood are the two most important needs of the poor that must be addressed immediately. Open your hands wide and help the poor whenever you can and wherever you are.

I am happy to be part of an organisation that is planning ahead for the next three years as this is what they anticipate would require to get the economy back on its wheels for the poor.

Immediately – food, then-livelihood and then long-term rehabilitation with resilience. They have valuable experience from implementing rehabilitation programs after the tsunami of 2004. They anticipate this after math of COVID 19 is going to be similar.

Keep safe distance. Wash hands with soap and water. Wear mask while going outside always till the end of the pandemic. Remember the poor. Help them in whatever way you can. May God bless you and keep you safe from COVID 19.

Why is Covid 19 low in India?

I wanted to share my thoughts on Covid 19earlier. Dr Devadas’ article has made me write my thoughts on this now. I do not want to go into health aspects of Covid and the strategies being implemented to contain the disease in India. Most of you are well versed on these.

In 2005 the whole world was working on a figure of 12 million HIV/AIDS cases in India. When I went into the interior pockets of Andhra Pradesh, there was a stark contrast with a significantly larger number of cases in coastal AP than in interior AP. Further unlike in Africa no village was being completely wiped off even in areas with high prevalence. It was concluded that India was under reporting.

By 2006, following a well planned study, it was concluded that India had only around 2.5 – 3 million cases of HIV/AIDS.

I think a similar story is repeating itself in Covid 19 as well. I am thankful to Dr Devadas for sharing two useful graphs which show the true Indian picture. In his paper he has argued very clearly that it is not under reporting or inadequate testing. If there were more cases, they would naturally seek medical care and get counted.

There is a fear that India with its apparently poor health infrastructure would do worse when compared to the European countries and the US. Most of these countries are working on non communicable diseases and not communicable diseases as India is handling both. Now the bundling of countries along with India must be seen along with the subsequent global map.

If you look the actual data and link it with the map below, there is one pattern that emerges. Most of the countries bundled with India are from the tropics. The countries with large numbers are from the northern temperate zone. When this pandemic started the entire Southern Hemisphere was experiencing summer. When the disease arrived in India we had just started our summer months. Right now Tamilnadu has begun experiencing extreme summer weather. Dr Devadas alluded this in his paper that the hot weather might be one reason why the disease has not spread as much as in the temperate countries. I believe this is the first and the most important cause for the difference.

Dr Devadas also alluded to another possible factor also mentioned by Dr George Kurian elsewhere that the Tamilnadu population has got gut immunity because of infection with other corona viruses, based on earlier studies in CMC Vellore. This could be the second possible reason.

The third possible reason is the diet pattern of Indians in general. The natural foods that go into our daily diet, is considered to be immunity building foods. In a jocular manner, someone brought in A Face Book post that the ‘rasam’ of Tamilnadu is good for this disease. If you know the ingredients that go into ‘rasam,’ they all enhance immunity. In many villages, a herb ‘thuthuvalai’ is used routinely, which is considered as immunity enhancing herb.

This was brought home to me very clearly just about the time prior to the arrival of ART in mass treatment for HIV/AIDS. At that stage, a diagnosis of HIV/AIDS was a death certificate. And then suddenly I saw in a project a number of HIV/AIDS patients with CD4 counts of 500 plus. As I analysed them further, they were consuming herbs in a significant manner. The first was moringa leaf juice. The second was aloe vera juice and finally rosella or the famous ‘gongura.’ All these are supposed to naturally increase immunity.

I know there is a scepticism on natural foods and their healing power. I wish critical scientist would carry out well controlled scientific lab based studies and either disprove or prove their effectiveness in natural healing and enhancing immunity.

The fourth factor I would like to add is that the government has gone on a war footing. They did bungle up the Delhi meeting a bit. Otherwise the government has done significant interventions to control the disease.

Finally as one who believes in prayer and God’s answers to prayer, Tamilnadu has been one of the key epicentres of Global prayer. I believe God has answered the prayers of a large number of people throughout the world, especially those originating from Tamilnadu.

I would certainly value criticisms and feedback to my thoughts. When the pandemic is controlled it would be interesting to see what were the real factors.

A micro-graph of a sneeze

I came across this type of image shown below when I was medical student over 50 years ago. Now with the focus on safe distance between individuals, this image would explain why that advice is sound.

Aerosols spread by sneezes
Source: Center for Disease Control USA.

Just a look at ths image would influence people to maintain a safe social distance.

Rajaratnam Abel

The role of the private health sector in the Covid 19 pandemic-sharing a post by Dr Prabir Chatterjee

A well written post by Dr Prabir Chatterjee. This certainly needs wider dissemination. Please share it widely adding your own comments.

Patients suffering from cough and cold stand in a queue outside an OPD to get checked during coronavirus pandemic, at Government JP hospital in Bhopal, Monday, March 23, 2020. (PTI Photo)
A notable aspect of the COVID-19 pandemic unfolding in India, which has not been commented upon much so far, is the low profile maintained by the huge private healthcare sector. The first death from COVID-19 in India was of an elderly man from Karnataka — who was shifted between private hospitals in Kalaburagi and Hyderabad, before dying during his return to Kalaburagi — exposing poor coordination of private hospitals with public health authorities. Subsequently, there have been reports from Rajasthan and other states of certain private hospitals refusing to admit patients with COVID-19 symptoms. In a country where over 70 per cent of healthcare is provided by the private sector, we need to take a close look at the role of public health system as well as private providers, during such epidemics.

Public health systems are now under pressure to perform a range of complex and evolving functions, including public awareness, prevention, surveillance, epidemic control involving tracing, isolation and quarantine, laying down standard protocols, and treatment of patients without refusing anyone on financial grounds. They are doing a reasonable job, despite considerable constraints. Private health care provisioning cannot replace these public functions. Effective primary health care organised by public bodies is essential to detect cases at early stage, and then to both isolate and treat them. In this context, excessive focus on programmes for secondary and tertiary care involving private providers, such as Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat, might need rethinking. Note how this much-projected scheme has so far been of negligible relevance during the COVID-19 epidemic. Data for last two years shows that in the Union Health budget, the share of National Health Mission (dealing mostly with public health services at primary and secondary levels) has dropped from 56 to 49 per cent, while the share of health insurance schemes has risen from 4 to 9 per cent. Is this the policy direction we want to continue?

Further, if the epidemic does spread significantly, there will be need for many more hospitalisations, with around 5 per cent of total cases needing advanced care with ventilators, ICUs etc. This could mean tens of thousands of serious cases concentrated in few areas. The existing capacities of public hospitals will be massively overstretched, since many district hospitals do not have the required facilities due to neglect of public health services in many states. If private hospitals are involved, will the dominant model of ‘strategic purchasing’ of services from private healthcare providers, paid on per case basis (as in PMJAY) be adequate to ensure seamless coordination of care, when there is a crunch? Seems unlikely, if we go by the experience of children affected by Acute Encephalitis Syndrome in Muzaffarpur last year (which claimed over 150 young lives). The vast majority of patients were ultimately treated by the main public hospital in the district, with PMJAY associated facilities playing only a peripheral role. An alternative approach has emerged in Kerala, where the Ernakulam District collector has asked private hospitals and non-governmental institutions to make available their medical and paramedical staff to public agencies involved in controlling COVID-19. Spain has moved one step forward, by bringing all private hospitals under public control during the epidemic; Ireland is considering similar steps.

The current epidemic also reiterates the importance of unbroken coordination between primary, secondary and tertiary levels of healthcare. In this context, we might question the recent Niti Aayog proposal to hand over large District hospitals to private operators in PPP mode, shifting these hospitals out of direct public control. Further these key public facilities would mostly start charging half of their patients at commercial rates. Such privatisation would weaken public health capacities, while fragmenting coordination across levels of care., and increasing the probability of denial of care to those unable to afford, in situations like the emerging scenario when services would be needed the most.

The US experience also demonstrates limitations of private agencies in dealing with public health emergencies. COVID-19 testing was left to commercial health insurance companies, leading to low levels of testing of the population, despite the growing epidemic. Only after serious questions were raised in US Congress, the official Centers for Disease Control assured that they will make free testing available to all, irrespective of health insurance coverage.

Taking all this into account, there is no alternative to infusing much higher level of resources into public health systems. This involves increasing public health budgets substantially, at least to achieve the National health policy goal of elevating public health spending to 2.5% of the GDP by 2025 (currently it hovers around just 1.2 per cent). This must be linked with employing a much larger pool of regular, skilled humanpower which must be done urgently in most states; this will not only upgrade public health capacity, but will also increase employment, giving a boost to the economy. More immediately some priority areas would be – expanding testing to cover not just travellers and contacts, but any clinically suspected person; ensuring preparedness of larger public hospitals with ICUs, ventilators, oxygen supply etc.; strengthening the Integrated Disease Surveillance Programme; and involving voluntary health agencies in generating widespread scientific awareness about do’s and don’ts related to COVID-19.

In parallel, essential obligations of private healthcare providers — mandatorily contributing to disease notification and surveillance, adopting standard treatment protocols and quality standards, and working in coordination with public health services to treat cases in epidemic situations – must be emphasised. In line with the Ernakulam approach, public health authorities may need to insource beds from charitable and large private hospitals at standard rates, to deal with cases which cannot be managed by public hospitals alone. The private healthcare sector also needs to move beyond resisting regulation and focussing on profit maximisation, towards accepting public health goals and social accountability. The state must improve its capacity for providing technical direction and organising fair regulation of private providers, towards harnessing these resources in public interest. Both arms of action – public health system strengthening and private sector regulation – must be accompanied by strong provisions for social accountability, transparency, and patients’ rights, to ensure that misuse of power is minimised, while public interests remain paramount.

Epidemics such as COVID-19 starkly remind us that public health systems are core social institutions in any society. No amount of strategic purchasing or outsourcing to private actors can replace their irreducible role. At the end of the day, it is public health services which will stand by our side in times of epidemics, and we must give highest priority to strengthening them. We dare to ignore this message only at our collective peril.

Welcome to my participatory, interactive and learning blog.

God has been good to me in teaching students in a participatory manner. I thought it would be useful to apply this to the many unanswered questions that people are grappling with.

I do not have the answers for these questions. However when addressed and participatively through the social media we may learn some answers. Here are some sample questions.

Why are plastics banned?

Is microwaving of food harmful?

Is brown sugar healthier than white sugar? Yes? No? Why?

Why do increasingly people are moving to natural herbal foods?

There are other questions that have not been adequately discussed and real scientific information has not been brought out into the open.

In the blogs coming up subsequently, I would liKe to bring up one topic at a time and see what information is available on each of them.

May be you have questions, please bring them up and let us see if we can discuss them. To avoid overlap, I would like to take up one topic at a time.

This blog is not to promote the marketing of my books. Occasionally I will introduce some of my books. But I will not put pressure on you to buy any of my books. Most of the time, I may request you to share such info if you find them useful.

To avoid cluttering up other social media sites, I would like you to work on my blog if possible. All my messages from my blog would come to Facebook and LinkedIn friends.

So let us get started. Please join in the blog.

I look forward to seeing more of you participating together.

Rajaratnam Abel

%d bloggers like this: