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.

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

Sharing info on Coronavirus

Rajakumari Stephen

6 March at 08:58 · Steve Stirland28 February at 12:19

IMPORTANT ANNOUNCEMENT – CORONAVIRUS

I received this information from my sister Rajakumari. I thought that this message provided simple but useful info. I am sharing it. Please share it if you find it useful.

Last evening dining out with friends, one of their uncles, who’s graduated with a master’s degree and who worked in Shenzhen Hospital (Guangdong Province, China) sent him the following notes on Coronavirus for guidance:


1. If you have a runny nose and sputum, you have a common cold
2. Coronavirus pneumonia is a dry cough with no runny nose.
3. This new virus is not heat-resistant and will be killed by a temperature of just 26/27 degrees. It hates the Sun.


4. If someone sneezes with it, it takes about 10 feet before it drops to the ground and is no longer airborne.
5. If it drops on a metal surface it will live for at least 12 hours – so if you come into contact with any metal surface – wash your hands as soon as you can with a bacterial soap.
6. On fabric it can survive for 6-12 hours. normal laundry detergent will kill it.


7. Drinking warm water is effective for all viruses. Try not to drink liquids with ice.
8. Wash your hands frequently as the virus can only live on your hands for 5-10 minutes, but – a lot can happen during that time – you can rub your eyes, pick your nose unwittingly and so on.
9. You should also gargle as a prevention. A simple solution of salt in warm water will suffice.
10. Can’t emphasise enough – drink plenty of water!


THE SYMPTOMS
1. It will first infect the throat, so you’ll have a sore throat lasting 3/4 days
2. The virus then blends into a nasal fluid that enters the trachea and then the lungs, causing pneumonia. This takes about 5/6 days further.
3. With the pneumonia comes high fever and difficulty in breathing.
4. The nasal congestion is not like the normal kind. You feel like you’re drowning. It’s imperative you then seek immediate attention.


SPREAD THE WORD – PLEASE SHARE.

At last! Indian version of my book.

At last the Indian version of Businessmen for the Poor is available online. I am happy to announce that it is available in the following  link.

https://notionpress.com/read/businessmen-for-the-poor-1330766-1330766

Till now only the Amazon.com version was available from the US at Dollar prices. I needed an Indian priced book to be made available for my Indian friends. It has taken a longer time than I imagined.

So, here it is. I trust that those who are involved in poverty reduction would find this useful in their work.

This book brings out many successful strategies carried out by RUHSA Department of CMC Vellore in poverty reduction.

I would value your critical feedback and suggestions.

I thank and praise God for giving me the opportunity of working for poverty reduction over a lifetime and then the wisdom in conceptualizing that experience into useful knowledge.

Please read and share this information with those who are involved in poverty reduction in India and elsewhere.

Thanks

Abel

Gate of the year

As you tread on the gate of the year 2020, I wanted to leave with you a poem written by Minnie Louise Haskins. I read this first in the devotional by Mrs Charles Cowman. I always liked these words, the first five lines of a longer poem. May our loving Master be the light to guide you safely through the new year.

THE GATE OF THE YEAR

And I said to the man who stood at the gate of the year:
“Give me a light that I may tread safely into the unknown.”
And he replied:
“Go out into the darkness and put your hand into the Hand of God.
That shall be to you better than light and safer than a known way.”

Happy new year and may God bless you.

Rajaratnam Abel

Good bye 2019

I want to take this opportunity to close the year 2019, recognizing and thanking our loving Master for all His blessings during this year.

By His sheer grace, I have completed one complete year after having had a bypass surgery in Dec 2018.

I narrowly missed very severe complications of a drug reaction to one of the drugs given post op heart surgery. It was entirely His mercy that I pulled through that as well.

My boook ‘Businessmen for the Poor’ was published this year after unexplained delays. With God’s loving blessings, I hope to build up on that during the coming year.

The next book on Dr John Scudder is getting almost ready for publication, as it is with the editor for the final edit.

During the year we had the privilege of celebrating the bicentenary of Dr John Scudder’s first landing in Calcutta on Oct 17th 1819. We had a monthly write up through the NSM newsletter Aatharam.

We have compiled almost all the monthly articles into the October issue of the English version of AAtharam. Those interested may get a copy of this newsletter from Navjeevan Seva Mandal. Please contact nsmsevoor@gmail.com or from my email at abel_rajaratnam@hotmail.com

I look forward to the new year 2020, when it is hoped we could learn together on some of the issues that are faced in our life journeys. I hope to interact with more of you more often in the coming year.

Rajaratnam Abel

Good rains for Chennai

This summer we struggled with water as Chennai was water starved. So when we had rains this Novemebr it was very refreshing.

Now all the water bodies near our home are full. This has enabled us to get good water supply through our bore wells.

Last summer at the height of drought, our bore well would pump water for only five minutes at a time. With the rains the water table has come well. Our vacant neighbours’ plots have about 6 inches of standing water. Now the bore motor pumps without stopping.

You’ll be surprised, the water was so plentiful, water was flowing like a stream along the street in front of our house for a number of days.

However, the number of flats have come up in such large numbers, I am not sure how long this bountifull wate rsupply would last.

We are thankful to God for His mercies in providing us the water.

Rajaratnam Abel