Rajaratnam Abel

As a public health physician, recently I was asked for my opinion on whether people should take the COVID-19 vaccine when it is made available.

When I first published the book on COVID-19, there was no vaccine. Then I shared the manner in which vaccine trials are conducted. Now many of you are aware of the different phases of trials for the vaccines. Now the vaccines are beginning to be available in different countries. It is likely to be available shortly in India.

I am using the term ‘when made available,’ because the government of India at least is planning to start with high priority groups first, starting with health care workers, frontline workers and then senior citizens and then come down the line.

One of the purposes of doing phased trials is to determine the effectiveness of the vaccine as well as identifying the side effects. With the vaccines being now approved for use, the recorded side effects are being made public.

Before I attempt to answer the question, we need to understand that the community is already divided into two broad categories of people with two groups in each. The first category is those who advise people to take or not to take the vaccine. The second category is the group where already some have decided that they will not take the vaccine and the opposite are those who have chosen to take the vaccine.

The whole world has put so much hope on a vaccine to get out of the COVID-19 problem, it may not meet all our expectations.

Having said this, now let us look at the issues involved in understanding the vaccine and its use with COVID-19. I have looked at the three leading vaccines namely the Oxford-Zenca, The Pfizer and the Moderna vaccines.

The first issue is what is called efficacy. That means, what percentage of protection does the different vaccines provide. The WHO has indicated that any vaccine that is more than 50% is acceptable.

The Oxford Zenca vaccine has displayed protection from 70 to 90%, with Pfizer 95% and Moderna 94%.

We are not sure how long the immunity produced by the vaccine would last. Would there be a need for repeat vaccines and how often? We do not have complete answers for these.

One of the logistic issues relating to some of the vaccines is the need for very low temperatures. It may not be easy and in such situations, those that require lesser temperature requirement may be more acceptable.

Whatever be the situation, just because you have taken the vaccine, do not become complacent and become careless. We still do not know enough of the disease, much less the value of the vaccines being promoted now.

Someone has indicated that it would be better to be cautious of any rushed vaccine. “Would you take the Pfizer vaccine tomorrow?” That was the question asked of nurses and support staff in a cancer centre. Their immediate answer was, “No. We are not required to take it.”

So, what would my advice be? If the vaccine is made available to you, by all means take it. We do not know how much rush there would be in the initial phases, and whether we will be forced into crowds to get the vaccine. I hope soon you have more information to make an informed decision on the vaccine to be taken when available.

Just a figure below to show how people in different countries are looking at the vaccines coming in for COVID-19.

I am writing this post after burying one of my close contacts, another victim of Covid 19. He was healthy and strong. He was young for his age. He was very careful in taking precautions for preventing the disease. He hardly went out of his house. He only went to his office and returned home. 

But once he had to attend work outside his office. He was probably careless on this day and the Covid virus attacked him. He just never got out of it, dying after a month of struggle. What a wasted life! Just with one risk in six long months of careful control, he was gone.

In recent posts, I have been posting different aspects of Covid disease. Without any hesitation I would like to emphasise the importance of consistent actions of wearing masks, keeping safe distances and maintain hygiene with washing hands with soap and water or sanitising. These are the only actions that can help in preventing this disease.

In India I see so many people being careless with these practices. Don’t stop wearing masks. If others don’t wear masks, you maintain safe distances.

I feel sorry for the people of the US. Even after so many people dying, still people are debating about the usefulness of masks and safe distances. Some are even demanding the right to not wear masks as it infringes on their rights.

Consistent correct mask use, safe distances and sanitized hands are the best methods of preventing this disease.

My close contact gave that virus one chance and it took him away.

Don’t give a chance to the Covid virus. It will attack you. It may cost you your life.

You may want to read more from my book COVID 19 or share it with friends and contacts.

Book COVID-19

Global eBook COVID-19 http://tiny.cc/gb01tz 

Indian eBook COVID-19 http://tiny.cc/bb01tz 

Rajaratnam Abel

When a patient gets admitted into a ward for care following a COVID-19 infection, besides specific medicines that need to be administered, providing oxygen depending on its saturation level and the need to respond to the level of breathing difficulty is the major medical intervention.

When a patient is inside an ICU, relatives outside often do not know how to interpret the oxygen support that is being provided to the patients. This blog is an attempt to explain the different devices through which oxygen is administered.

There are four broad methods or devices by which oxygen is administered to a patient admitted for COVID treatment. The following are the common oxygen delivery devices.

1.    Nasal cannula, adult and paediatric (single use).

 They are connected to a lip support and a fully adjustable harness (one tube right/left side). It is a cannula with twin nasal prongs designed for easy administration of medicinal oxygen through the patient’s nostrils

This is the first level of providing oxygen to COIVID-19 patients who need oxygen support. It can deliver 1–6 Litres of oxygen per minute and deliver about 24–44% of oxygen. Humidification may be necessary especially for children. It is easy to use and the patient can eat and talk.

2.     Mask with a reservoir bag; adult type. 

This is a non-rebreather mask with a reservoir bag. It is used to deliver medical oxygen directly to the upper airway of the patient. It includes two unidirectional valves, one that closes during inspiration to prevent room air mixing with oxygen in a reservoir bag; and one that closes during exhalation to prevent exhaled respiratory gases from entering the reservoir bag.

This is the next level of providing oxygen support. It delivers > 10 Litres per minute and delivers 80–95% oxygen at a higher level of concentration. To be effective the flow should be maintained at > 10 L/min as lesser concentration can cause the bag to collapse during inspiration.

3.    Venturi mask; adult and paediatric types.

It is also known as pressure mask or an air-entrainment mask. It delivers oxygen, with a specific concentration from 24–60% minimum. It has an adjustable nose clip.

This is third and highest level of oxygen support without connecting to a ventilator. It can deliver from 2–15 Litres per minute/min and meet 24–60% oxygen need according to the type of mask. It allows precisely measured amount of oxygen to be delivered. It comes in different colours to indicate the flow rate. It confines some patients and it interferes with talking and eating.

Today, many patients are managed with the above three different levels of masks without taking the patient on to a ventilator. If a patient is taken from the first level to the second or third level, it indicates that the patient is not doing well. On the reverse if a patient moves from level three to level two or one it indicates that the patient is improving. This is called non-invasive intervention.

4.    Ventilator

A ventilator is a bedside machine with tubes that are inserted inside your airways. The air flows through a tube that goes in your mouth and down your windpipe. It mechanically helps pump oxygen into your body. The ventilator also may breathe out for you, if you can’t do it on your own. The breathing tube may be uncomfortable. While it’s hooked up, the patient can’t eat or talk. This is called invasive intervention.

The following are the indicators for starting a patient on ventilators, rapid progression over hours, lack of improvement with noninvasive methods, hypercapnia or when there is retention or too much carbon dioxide (CO2) in the blood, normally caused by reduced air flow into the lungs, haemo-dynamic changes indicated by low blood pressure and or signs of heart failure, or multi-organ dysfunction indicated by failure of different organs, and altered neutrophil-lymphocyte ratio among white blood cells.

There is a fear in the minds of people that when patients are put on ventilators, that many will die. While in the early days of COVID-19, many who were put on ventilators died, as we did not have proper medicines. Today, many patients who are connected to a ventilator survive, because we know more about the disease and how to manage it.

I hope to cover and share other information about COVID-19 in other areas where we have a better understanding of the disease and how to treat such patients. But prevention is the best and safest as we do not know who will die.

Don’t take chances with the COVID virus. If you give it a chance it will attack you. Wearing mask, keeping safe distance and frequent washing of hands with soap and water or sanitizing is the surest way of preventing the disease.

If you are interested in knowing the full COVID story, you can access the book on the disease available in the following link.

COVID-19

Global eBook http://tiny.cc/gb01tz

Indian eBook http://tiny.cc/bb01tz

Rajaratnam Abel

Well, why do I write at this age of seventy-five years? It all started as a young physician when I started out on my medical career. From my experience I wanted to contribute something to society beyond just treating patients day in and day out.

I knew writing was one of the ways I could contribute. In my first ten years I published two articles in a church magazine. One was about forgiving a person who tried to steal something from my backyard. The other was my understanding of how small pox was eradicated from India.

But in the last 25 years of my professional career, I got into a project involved in plenty of health-based research as well as valuable experiences in overcoming poverty and improving the health of the people, especially the poor.

So, plenty of scientific articles flowed out of my pen. I did not write them alone. I was almost always part of a team of authors who did the work together. In a way, my desire to contribute got fulfilled. God gave me the privilege of writing over 75 scientific articles.

My first book came out just three years before I retired. I had taken a sabbatical of three years, when I completed my PhD as well as the book. Unfortunately, I did not publish it through regular publishers. I had enough official money to print the book. I just printed and distributed it freely as it was an official book.

Only when I retired, did I find out the value of formally publishing through publishing companies. Again, God has enabled me to publish 4 books over the past five years, through online publishing.

So, why am I publishing. The basic purpose is the original one of contributing. In principle it means sharing my experiences of a life time serving the poor in their health and economic needs. What a rich experience God gave me!

An author is supposed to make plenty of money. When sharing experience and knowledge was my goal, money took a back seat. Oh yes, I could do with more money. That was not my goal. So, I make my book freely available especially the eBooks for readers to download it free.

More people have downloaded free than purchased my book. I wish even more had downloaded free. I will continue to make them free whenever Amazon gives me the privilege.

What I have learnt from experienced authors is that an author should never ask people to buy his book. So, always my request is that those who read the announcement of my books, forward to someone whom they think would benefit from that book. Some may buy, others may not.

Therefore, I am sharing information about the books that are in the online market place. I intend to share information about my books online in every blog I write.

My web site

www.rajaratnamabel.blog

Businessmen for the poor

Global Paperback  http://tiny.cc/q901tz

Global eBook http://tiny.cc/f801tz

Indian eBook http://tiny.cc/k901tz

Paperback Indian http://tiny.cc/6f71tz

COVID-19

Global eBook http://tiny.cc/gb01tz

Indian eBook http://tiny.cc/bb01tz

Dr John Scudder

Global eBook http://tiny.cc/ob01tz

Indian eBook http://tiny.cc/wb01tz

In one of my subsequent blogs, I’ll write about the rich and varied experience that God gave me in my life time of service. Besides writing, God has given me the privilege of teaching students in two different institutions.

The first and major one is teaching MBA students of a leading university on introduction to health and environment. The other one is to teach community health management to development practitioners.

However, I look forward to an ongoing dialogue on different topics where it was possible to bring about changes in the community, especially in the development of the poor. I would value critical comments and pointed questions challenging some of the thoughts I present.

I look forward to your kind criticisms and feedback.

Rajaratnam Abel

What are the current rules on socialising?

So far we have been talking about social distancing. Now there is a new terminology introduced. That is socialising. It refers to how many people can meet together in social settings.First I share information from different countries that is available. While there are specific rules in different countries what I present are the general guidelines applicable anywhere. 

Remember, maintainI got social distance and wearing a mask or having your face covered is the safest practice to prevent getting COVID-19 disease.

People in Northern Ireland and Scotland are no longer allowed to socialise in their homes with people they don’t live with. 

In England, a maximum of six people from multiple households can meet up both indoors and outdoors – in private homes, pubs, restaurants and parks. All ages are included in the headcount. There are some exceptions – for example when a single household has more than six occupants.

In Scotland, people are being told not to visit other households or other private indoor spaces. 

In public indoor spaces, where Covid-secure guidelines are observed, six people from two households can gather. The same rule of six applies in outdoor spaces, including private gardens. 

Children aged 11 or under will be exempt form the headcount. Young people aged 12 to 18 will also be exempt from the two household limit and allowed to meet together outdoors in groups of six. 

Northern Ireland has also announced tougher rules. Social mixing of households is not allowed inside private homes although there are some exceptions.  

Up to six people from two households can meet in private gardens. In other places, both inside and outside, up to 15 can gather with social distancing.

In wales it is now illegal for more than six people to meet indoors. Even then the six people must be from the same household.

However, people living alone in areas under local restrictions can now meet one other in household indoors, Children aged 10 and under do not count in the total. 

How can we generalise from this? The number six individuals seems to stand out as the permitted number. Children apparently do not count in this number. Even in families with more than six members this does not count. This applies to socialising indoors.

Outdoors socialising seems to be a bit more liberal going up to fifteen individuals.

In practical terms, what this means is that birthday parties are out. Similarly there are local guidelines that apply to weddings and receptions varying from place to place. 

There are strict guidelines on attending for funerals. Again it varies from place to place, with 30 being the highest number I have seen.

What are the rules on mingling?

The guidelines for England refer to times when “mingling” could break the rules. It says “there can be multiple groups of six people in a place, provided that those groups do not mingle”. 

If you are at a restaurant or other venue, you should “avoid mingling with anyone outside the group you are with, even if you see other people you know”. 

People attending a protest, or other organised event, should also attend in groups no larger than six.

The following are the exceptions to the rule of six. If your household is larger than six, education and training, workplaces, protests and political events, if coronavirus rules are followed, jury duty or other legal commitments, children’s play groups and youth clubs, support groups, such as for addiction or abuse.

What is the guidance on social distancing?

Social distancing has wavered between 1 and 2 metres. At the upper end the advice is to stay 2m (6ft) away from anyone you don’t live with. This is safer than the 1 metre distance. The exception to this is, you can stay 1 metre away if you do something “plus” such as wearing a face mask or face covering. There is also the realisation that the 2 metre distancing may not be realistic in situations like hair dressing.

These are guidelines that are emerging as we see the COVID-19 not going away as many would desire. There’s safety in following these guidelines.

Those of you who are interested in obtaining or sharing my book on COVID-19, may click on the links below for the global eBook or the Indian eBook respectively.

https://is.gd/bmwZ8Q

https://is.gd/xtDLeI

Rajaratnam Abel

In spite of all the efforts made by different countries of the world, COVID-19 continues to spread. Leaders are struggling to contain the spread of the disease. So, what must be done to stop the spread?

The only effective method we know that could control the spread of the disease is wearing mask correctly and consistently and maintaining safe distance. Both these practices are not being followed strictly.

Young people are the biggest law breakers. This is followed by some shop keepers. They do not insist on customers wearing masks either.

Many who wear a mask, wear them incorrectly. They do not cover their noses with the masks. It is really no use wearing masks in this fashion.

Compliance by shops must be given priority. Big shopping centres are the biggest culprits. They must be warned to comply. Repeated non compliance must be punished by sealing and closure for two weeks. This must be widely publicised through the media. Then small shops will fall in line.

Not wearing mask is more dangerous than not wearing helmets. If a person who did not wear a helmet met with an accident, it was his life that was in danger. But with masks they are creating problem for others and must be handled even more strictly.

People who go by bikes or walk through the roads without mask must be stopped and made to report to an officer a little further away. They should be harassed by making them wait to see the officer and lose time.

Customers must insist on shop keepers wearing masks when serving customers. Make a bit of noise. Create a scene. Shop keepers will fall in line soon.

Insist on fellow customers to wear masks. If they refuse again create a scene in the shop. But take steps to keep a safe distance yourself. Treat those who do not wear masks as untouchables. Force them to keep distance.

Elders in homes must insist on youngsters wearing mask whenever they go outside. This has to be repeated over and over again.

Everyone has to take responsibility for this task. Those who wear masks should insist on others wearing masks. If people refuse to wear masks, other bystanders should come forward and support those who are demanding people to wear masks. They must be demanded to wear masks or even chase them out of the area. Others can start taking pictures and posting in the media.

COVID-19 does not respect those who break rules by not wearing masks and not keeping safe distance. It is not a time for nice and polite behaviour. Breakers of this rule must be firmly handled by society at large.

Remember, wearing masks consistently and correctly is the only way the spread of COVID-19 can be halted. Everyone must take responsibility.

Today, I went into a pharmacy. No one was wearing masks. A man walked in not wearing mask. When I asked the staff why no one was wearing mask, the man had the audacity to say, “nothing will happen if you die.” None of the staff reprimanded the man for such an answer.

On returning home, I complained on the website of thepharmacy. Someone responded and apologised for the failure in their pharmacy and indicated that instructions are being given to ensure everyone wears masks. Only if people take responsibility to follow up then people will fall in line.

Just for those who are interested to obtain a copy of the eBook I had written, COVID-19, or those who would like to share with their friends, the eBook is available in the following links.

Global eBook https://is.gd/bmwZ8Q

Indian eBook https://is.gd/xtDLeI

Rajaratnam Abel

Today I would like to share the good news that Christian Medical College, Vellore was given three awards in the care of COVID-19.

The first award related to work place for safety.

https://medicaldialogues.in/news/health/hospital-diagnostics/caho-confers-top-awards-to-cmc-vellore-gmc-chennai-columbia-asia-for-workplace-safety-amid-covid-19-69727

The second award was related to excellence in hospital preparedness

“Excellence in Hospital Preparedness for COVID-19”

• awarded by the Federation of Indian Chambers of Commerce and Industry (FICCI)

The third award was for best charitable hospital

• Best Charity Hospital combating COVID-19“
  awarded by the India Today Group in the India Today Healthgiri Awards. Link to video here.

I want to focus on the last award. As a charitable hospital it was a big challenge. Because of COVID 19, other general patients stopped coming as well as the lockdown which prevented the regular flow of patients.

It is within this major challenge, that CMC Vellore was able to continue providing charitable services.

CMC needs the continued support of friends and well wishers to continue its charitable services. Please feel free to share with those who could contribute during this of need in serving the poor in health care.

You can feel free to contact me as well by responding to this blog in the comment section.

Alternately, you can contact me in abel_rajaratnam@hotmail.com

Thank you so much.

Rajaratnam Abel

One of the purposes of the book on COVID-19 is to prevent the disease. There are two levels at which action needs to be taken to prevent the spread of the disease. The first is at the individual level. It includes the following four tasks.

1. Stay at home always and as much as possible.
2. Wear a mask always while going outside and when in contact with others.
3. Maintain social distance of 1 metre plus mask or >2 M, always while going outside.
4. Wash your hands with soap and water after coming back home and as often as possible. Alternately sanitisers may be used to keep the hands clean. (Those who have been outside for extended periods of time have a full bath when they return home.)

When is it justified to go out of your home?

In an era where staying at home is the recommended norm, what are the reasonable and justifiable reasons or excuses to go out? The word reasonable is stated differently as what is essential, as people should go out as little as possible and only leave home if they have a reasonable excuse.

Well, here are the valid excuses for going out. Shopping for basic necessities is number one. Any medical need, or providing care for a vulnerable person would be number two. Number three would be travel to or from work, but only when it cannot be done from home. Exercise, either alone, or with members of your household would be the fourth and the last one.

Masks

Provided enough people wear masks when venturing out in public, it could have a dramatic impact on how quickly the spread of COVID-19 is curtailed, particularly if combined with other measures such as social distancing and hand washing.

Tests on homemade masks have shown they can still significantly reduce the spread of other viral infections such as influenza. They can also help to reduce the dispersal of the virus onto nearby surfaces when people cough.

Why is social distancing necessary?

Social distancing is important because coronavirus spreads when an infected person coughs, small droplets which are packed with the virus are dispersed out into the air. No one knows who is infected and might spread the virus. An infected person’s cough or sneeze is likely to disperse a large number of aerosols with the virus.

If you are close to such a person, you are likely to get a heavy dose of virus, which may make it difficult for the body to control through its natural immunity. There are clear indications that this virus is spread through the air and keeping safe distance is one sure manner of preventing the disease.

If a person without wearing a mask comes near you, you take steps to move away from that person. Keeping safe distance always will preventing contacting the virus.

Washing hands with soap and water

Besides airborne transmission of the virus through droplets containing the virus when someone coughs or sneezes, the hands become the next most important means of transmission by the hands coming in contact with the virus that may have settled on the surface of furniture, books or any other substance.

Therefore, cleaning hands often with soap and water helps to clear the virus. Soap is suggested because the virus has a fatty envelope. This gets cleared only with soap and water. While sanitizers are useful and should be used as often as possible, many poor people cannot afford it, so it is not emphasised here.

Government actions

This second action is at the government level either at the national level or even at the state or city level in larger countries. There are three major tasks involved at this level.

1. Increase rapid testing of the population as much as possible.
2. Promote, maintain and monitor contact tracing, self-isolation or quarantine as appropriate.
3. Diagnose early and treat those who are likely to become severely ill. Here’s your link to the book.

http://tiny.cc/scudder

• WordPress

I am thankful to God for helping me to bring out this newest eBook. It was released on October 1.

This book describes the life and story of Dr John Scudder who came to India over 200 years ago.

It was his granddaughter Dr Ida Scudder who started the Christian Medical College, Vellore.

It was because of these two individuals that I had the privilege of studying in this institution and then spending 27 years of my life work there.

I am making this eBook available for free download load today and tomorrow. Please feel free to download as well as share with those who might benefit.

http://tiny.cc/scudderi

Besides the above, my two other E-books are also available for free download.

Businessmen for the Poor available today in link below.

The links to the book Businessmen for the Poor are given below.

The e-version is available on the following link.’
Global https://www.amazon.com/dp/B07P7HVQCQ

I am also sharing the link to the eBook on COVID-19

Global https://www.amazon.com/dp/B08FRSNS73

I trust that you will have enjoyable reading.

Rajaratnam Abel

I thank and praise God for giving me 75 years of life. On September 11, I crossed this landmark in my life.

I am thankful for life itself as I passed through some dangerous moments. God was with me at these times.

I am thankful for the blessings He has given me in my life, family and work.

In my retirement years He has given me the wisdom to write from my lifetime experiences.

In the remaining years that has planned for me I want to make sure that I live for His glory.

As a mark of this landmark 75 years, I want to share with you a song that has appealed to me. I trust that you will enjoy it.

The link to the song is given below.

https://video.search.yahoo.com/search/video?fr=mcafee&p=link+to+talley+trio+praise+you#id=1&vid=1282ca8bc5cbe7bd69ea51bd30e0fb31&action=click

May this song be of meaning to you as it was to me.

May God bless you.

Rajaratnam Abel