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Saturday, May 01, 2021

The Only Disease Eradicated in the History of Mankind has been a Virus !

Only one disease has been completely eradicated so far - small pox - caused by a virus !

What follows is the story of how humanity did it...

A Virus Humanity Won Over

In 10,000 BCE, a deadly new virus emerged in Northeast Africa, killing indiscriminately and causing a disease we now know as smallpox. 

Around 180 AD, Small pox killed an estimated 5.5 million people in the Roman Empire, including the Emperor, and hastened its decline.

Smallpox kept revisiting countries and continents periodically with global migration patterns : China in the 4th century, Europe in the 7th century - and continued to kill millions of people. Generations watched helplessly as their children succumbed to the disease or were disfigured or blinded by it. 

The Japanese smallpox epidemic of 735–737 is believed to have killed as much as one-third of Japan's population.

Between 1868 and 1907, there were approximately 4.7 million deaths from smallpox in India.

During the 20th century, it is estimated that smallpox was responsible for 300 million deaths worldwide.  For perspective, the flu is supposed to have killed a 100 million people in 2018-2020. 

In the early 1950s an estimated 50 million cases of smallpox occurred in the world each year. As recently as 1967, 15 million people contracted small pox and two million died from it that year.

For Centuries, Inoculation was the only cure for Small Pox

Inoculation was likely practiced in Africa, India, China and Turkey long before the 18th century, when it was introduced to Europe. In China, powdered smallpox scabs were blown up the noses of the healthy. People would then develop a mild case of the disease and from then on were immune to it. There are hints of the practice in China from the 10th century.

Inoculation referred to the subcutaneous instillation of smallpox virus into non-immune individuals. The inoculator usually used a lancet wet with fresh matter taken from a ripe pustule of some person who suffered from smallpox. The material was then subcutaneously introduced on the arms or legs of the non-immune person. 

There were problems with inoculation though – some percent of the people still died, and some developed syphilis or other disorders due to the contamination that occurred in the procedure. 

A self-taught inoculator from Scotland, Notions found success in treating people from at least the late 1780s through a method devised by himself, despite having no formal medical background. His method involved exposing smallpox pus to peat smoke, burying it in the ground with camphor for up to 8 years, and then inserting the matter into a person's skin using a knife, and covering the incision with a cabbage leaf. He was reputed not to have lost a single patient despite inoculating thousands.

Establishing the idea of Vaccination

Edward Jenner, an Englishman, was the first to demonstrate that vaccination offered a reliable defense against smallpox. It was also a reliable defense against other illnesses, such as poliomyelitis, measles, and tetanus, although this was not known in Jenner's lifetime. 

It was 1796 before Jenner made the first step in the long process whereby smallpox, the scourge of mankind, would be totally eradicated - he vaccinated a small boy against small pox. 

In those years and throughout history, small pox killed 30% of those it infected and left nearly all the rest of its victims disfigured, or blind, or both. Some of its variants killed 100% of those they infected. 

Although he received worldwide recognition and many honors, Jenner made no attempt to enrich himself through his discovery. He actually devoted so much time to the cause of vaccination that his private practice and his personal affairs suffered severely. 

But his efforts bore fruit and soon most countries in Europe and in Americas had taken up national vaccination programmes around the beginning of the 19th century.

Many scientific discoveries were needed  to make large scale vaccinations possible

Until the end of the 19th century, vaccination was performed either directly with vaccine produced on the skin of calves or, particularly in England, with vaccine obtained from the calf but then maintained by arm-to-arm transfer. 

At that time, an Englishman, Sydney Copeman, found that vaccine suspended in 50% chemically-pure glycerine and stored under controlled conditions contained very few "extraneous" bacteria and produced satisfactory vaccinations. All vaccinations supplied by the Government were subsequently from Copeman. 

In early 1950s, Leslie Collier, an English microbiologist developed a method for producing a heat-stable freeze-dried vaccine in powdered form. The dried vaccine was 100% effective when reconstituted after 6 months storage at 37 °C, allowing it to be transported to, and stored in, remote tropical areas.

Benjamin Rubin, an American microbiologist developed the bifurcated needle. Easy to use with minimum training, cheap to produce, using four times less vaccine than other methods, and repeatedly re-usable after flame sterilization, it was used globally.

The Final Push for Eradicating Small Pox

In Northern Europe a number of countries had eliminated smallpox by 1900, and by 1914, the incidence in most industrialized countries had decreased to comparatively low levels. In the 1950s, a number of control measures were implemented, and smallpox was completely eradicated in Europe and North America.  

The first hemisphere-wide effort to eradicate smallpox was made in 1950 by the Pan American Health Organization. The campaign was successful in eliminating smallpox from all countries of the Americas except four. 

In 1958 Professor Viktor Zhdanov, Deputy Minister of Health for the USSR, called on the World Health Assembly to undertake a global initiative to eradicate smallpox. At this point, 2 million people were dying from smallpox every year. Overall, the progress towards eradication was disappointing, especially in Africa and in the Indian subcontinent. 

In 1966 an international team, the Smallpox Eradication Unit, was formed under the leadership of an American, Donald Henderson, who was trained at the CDC. In 1967, the World Health Organization intensified the global smallpox eradication effort. Under Henderson’s leadership, the WHO established a network of consultants who assisted countries in setting up surveillance and containment activities, which were as crucial as vaccination in containing small pox. 

Early on, donations of vaccine were provided primarily by the Soviet Union and the United States, but by 1973, more than 80 percent of all vaccine was produced in developing countries.

Victory – after 3500 years of the first proven disease case !

After two years of intensive searches, what proved to be the last endemic case anywhere in the world occurred in Somalia, in October 1977. A Global Commission for the Certification of Smallpox Eradication chaired by Frank Fenner examined the evidence from, and visited where necessary, all countries where smallpox had been endemic. In December 1979 they concluded that smallpox had been eradicated.

On May 8, 1980, the World Health Assembly announced that the world was free of smallpox and recommended that all countries cease vaccination: 

“The world and all its people have won freedom from smallpox, which was the most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness and disfigurement in its wake”.

The cost of the eradication effort, from 1967 to 1979, was roughly $300 million US dollars. Roughly a third came from the developed world, which had largely eradicated smallpox decades earlier. The United States, the largest contributor to the program, has reportedly recouped that investment every 26 days since in money not spent on (a) vaccinations and (b) the costs of incidence. 

Thursday, April 29, 2021

Awake Proning to help with Oxygen Saturation

Patients on mechanical ventilation are known to halve their mortality by being administered proning positions (lying on your stomach, on your side, sitting up or walking about - but not lying on your back {supine position} or very little). 

But not many studies had been done for awake non-intubated patients in regard to proning, whether done by self or in hospital settings. 

However such studies have gathered pace during the Covid-19 pandemic. 18 such studies are summarized below. 

In one study in Nebraska, USA, after patients were educated on the benefits of awake self-proning, compliance was voluntary. The risk of intubation was lower in proned patients after adjusting for disease severity. No prone patient died compared with 24.6% of patients who were not prone.

Conclusions: Awake self-proning was associated with lower mortality and intubation rates in coronavirus disease 2019-infected patients. Prone positioning appears to be a safe and inexpensive strategy to improve outcomes and spare limited resources.

As the pandemic progresses, scarce resources (e.g., ICU beds and mechanical ventilators) may become a rate-limiting factor in the care for these patients. Therefore, therapies to prevent the need for intubation and mechanical ventilation are desperately needed.

We hypothesized that patients with COVID-19 and respiratory distress, not yet intubated but at high risk for intubation, might benefit from prone positioning. 

Ten adult patients at an academic medical center with confirmed positive PCR testing results, with rapidly increasing oxygen requirements necessitating ICU admission but not yet requiring intubation, were determined to be appropriate clinical candidates for proning.

Patients were asked to alternate every 2 hours between a prone and supine (lying on your back) position during the day and sleep in a prone position at night, as tolerated.

Oxygenation rapidly improved after prone positioning, and at 1 hour after assuming a prone position, median oxygen saturations had increased from 94% to 98%.

After prone positioning, work of breathing had improved, as evidenced by a reduced median respiratory rate from 31 to 22 breaths/min.

Eight of the 10 patients did not require intubation (being put on mechanical ventilator).

At 28 days of follow-up, all patients had been discharged from the hospital to their homes.

We enrolled 56 patients for a study in Italy. Prone positioning was feasible (i.e., maintained for at least 3 h) in 47 patients. It was effective in rapidly ameliorating blood oxygenation in awake patients with COVID-19-related pneumonia requiring oxygen supplementation. The effect was maintained after resupination in half of the patients.

Among 29 eligible patients in New York, 25 had at least 1 awake session of the prone position lasting longer than 1 hour; 4 refused the prone position and were intubated immediately. 

We found that the use of the prone position for awake, spontaneously breathing patients with COVID-19 severe hypoxemic respiratory failure was associated with improved oxygenation. In addition, patients with an Spo2 of 95% or greater after 1 hour of the prone position was associated with a lower rate of intubation.

Many critical hypoxemic patients were treated in wards in a Paris hospital due to lack of intensive care units bed availability. 

Twenty-seven patients were included in a study - confirmed Covid-19 hypoxemic patients who benefited from at least one prone position were included. Eighteen patients were responders (defined as an improvement of SpO2/FiO2 of more than 50) during the first posture and have a shorter length of hospital stay than non-responder patients. 

Our study found that prone position in wards improved alveolar exchange during posture and is well tolerated. However, oxygenation improvement did not seem to persist when the position was stopped.

Elharrar et al. have yet ascertained that only 25% were responders (had sustained improvements) to prone position.

On the other hand, Sartini et al. found that 12 of 15 patients had persistent oxygenation improvement after the posture’s end.

In a London hospital, forty eight of 138 patients managed outside of a critical care unit with facemask oxygen, high flow nasal oxygen or continuous positive airway pressure, underwent prone positions. 

Prone position was associated with significant improvement in oxygenation, lower ICU admission, tracheal intubation, and shorter ICU length of stay. Lack of response to PP may be an indicator of treatment failure, requiring early escalation.

The main outcome reported was that prone positioning improved P/F ratio from 17.9 to 28.2 kPa after 81 average min across 36 subjects, of which 26 had a response of ≥20%. Results from 32 subjects indicate that the response persisted on return to supine. 

In the current report, death or progression to extracorporeal membrane oxygenation was more frequent in those displaying a diminished response to further prone manoeuvres.

Six relevant studies, including an observational cohort study with 50 patients, and five case series with 53 patients were identified. All studies included, noted improved clinical symptoms after proning. In Elharrar et al., Caputo et al., and Paul et al., improved oxygen saturation of 20%, 10%, and 6% respectively from the baseline is observed. 

Additionally, in Paul et al. study, FiO2 requirements were titrated from 0.8 to 0.4 within one hour of proning. In the studies of Sartini et al. and Sztajnbok et al. PaO2: FiO2 was noticed to improve. 

In patients who underwent awake proning, it was noticed that only 13/50 (26%) in Caputo et al., 1/15 (6.7%) in Sartini et al., and 5/ 24 (20.8%) in Elharrar et al. studies needed mechanical ventilation. 

Similar results of reduced need for mechanical ventilation and improved oxygenation were found in Ng et al. study.

A total of 45 subjects were included (30 cases and 15 controls). The median duration of prone positions achieved was 7.5 h on the 1st day. 

The need for mechanical ventilation was higher in the control group (5/15; 33.3%) versus prone group (2/30; 6.7%). 

At 30 min, there was a statistically significant improvement in the mean ROX index of cases compared with that of the controls. 

No significant adverse effects related to intervention were noted.;year=2021;volume=38;issue=7;spage=6;epage=10;aulast=Sryma

An area of current study is the use of proning in awake, spontaneously breathing COVID-19 patients with respiratory failure outside of the ICU in an attempt to prevent escalation to intubation and mechanical ventilation. 

In one study, 50 patients with mild to moderate ARDS from COVID-19 requiring oxygen therapy outside of the ICU were treated with a protocol of prone positioning three times per day for 30-60 minutes alternating with supine positioning. 

Prone positioning was associated with significant increases in oxygenation during proning and after returning to the supine position as well. 

At 45-day follow-up, there were two deaths out of the 50 study subjects, seven patients required ICU admission, and 41 patients had been discharged from the hospital.

Awake proning is a practice that was adopted early in the pandemic as a means to avoid, or at least delay, endotracheal intubation to lessen the burden of ICU care.  

2994 patients were included in a systematic review and meta-analysis of observational trials comparing in-hospital intubation and mortality rates in patients treated with awake proning vs standard care.

27% of the Awake Prone needed intubation eventually, vs. 30% in Standard Care.

 11%  of the patients in the Awake Prone trials died eventually, vs. 22% in standard care.

Awake proning was associated with significant improvement of oxygenation parameters

Some studies showed this was sustained after patients returning to supine position. One study each showed that 50% of patients retained improved oxygenation after returning to supine position; and the other study said improvement was lost after returning to supine position.

A prospective study of 30 COVID patients admitted in our Hospital critical care isolation. Awake prone positioning and non-invasive ventilation showed marked improvement in SaO2 and PaO2 in COVID-19 patients with improvement in clinical symptoms with reduced rate of intubation with superiority of non invasive ventilation.

In the absence of effective targeted therapies for COVID-19, optimisation of supportive care is essential. Lung injury with features of acute respiratory distress syndrome (ARDS) appears to be the principal characteristic of severe acute respiratory syndrome coronavirus 2 infection. Recent guidance by the UK Intensive Care Society advocates awake prone positioning to become standard of care for suspected or confirmed COVID-19.

Valter et al applied prone positioning to four patients with indications for mechanical ventilation and found rapid improvements in PaO2—all patients avoided mechanical ventilation  and tolerated prone positioning well. 

In an observational study of 15 patients receiving non-invasive respiratory support for acute hypoxaemic respiratory failure, repeated prone positioning led to transient but substantial improvements in oxygenation. 

In a prospective observational study of 20 patients receiving non-invasive ventilation for moderate-to-severe ARDS, PaO2/FiO2 ratio increased by 25–35 mm Hg following awake prone positioning; but 78% of participants with severe ARDS eventually required mechanical ventilation (MV), and therefore awake prone positioning should not delay the use of MV when indicated.

In summary, awake prone positioning appears to be safe and may slow the respiratory deterioration in select patients with COVID-19, who require oxygen supplementation or NIV/CPAP. This in turn may reduce demand for MV, easing the strain placed on intensive care services around the world.

27 patients with confirmed COVID-19 pneumonia admitted to a Switzerland Hospital were included in the study. 10 patients were randomised to self-prone positioning and 17 to usual care.

 Self-prone positioning was easy to implement. Self-prone positioning in patients with COVID-19 pneumonia requiring low-flow oxygen therapy resulted in a clinically meaningful reduction of oxygen flow, but without reaching statistical significance.

In a study of 25 patients with COVID-19 and hypoxemic respiratory failure managed outside the ICU in France, 63% were able to tolerate prone position for more than 3 hours. However, oxygenation increased during prone position in only 25% and was not sustained in half of those after resupination.

27 spontaneously breathing adults with COVID‐19 admitted to Austin Hospital in Australia were selected for a study.

Twenty (74%) patients received proning at least once, six (22%) never received proning despite clinical indication (e.g. refused) and for one patient proning was documented but no data were available.

For the patients who received proning, the median number of treatments per patient was three, and their duration was 105 minutes.

In summary, in spontaneously breathing patients with COVID‐19, on an analysis of close to 100 treatments, we found no evidence of reproducible response to proning and no relationship between the effect of proning on first treatment with subsequent treatments.

Infection with SARS-CoV-2 can result in Coronavirus Disease–19 (COVID-19). While the majority of patients are asymptomatic or have mild disease, approximately 14% develop more severe disease including hypoxemic respiratory failure and/or Acute Respiratory Distress Syndrome (ARDS). A synthesis of 35 studies (414 patients) was carried out, that examined the use of awake prone positioning for non-intubated patients with hypoxemic respiratory failure.

The duration of prone positioning sessions varied from <1 h to >18 h and was not reported in three studies. All studies demonstrated improvements in oxygenation while patients were in the prone position except one. When reported, improvements in oxygenation were generally not sustained after returning to the supine position except in two studies in which patients were receiving NIV (Non-Invasive Ventilation assists breathing by supplying a mixture of air and oxygen using positive pressure to help the patient to take deeper breaths). One hundred twenty-one patients (29%) of the 414 patients required invasive mechanical ventilation. Adverse events were variably reported and included 42 deaths among the 414 patients (10.1% of all patients).

In summary, although awake prone positioning may be a promising therapy for patients with hypoxemic respiratory failure (including those with COVID-19), the supporting evidence is limited to case reports and cohort studies.

60 patients diagnosed with acute hypoxic respiratory failure secondary to COVID 19 pneumonia requiring 4 or more litres of oxygen to maintain a saturation of  92% were recruited in this study. 

Thirty patients each were randomised to either standard care or awake prone group. Patients randomised to the standard care were allowed to change their position as per comfort and patients randomized to the prone group were encouraged to self-prone for at least 6 hours a day.

In the prone group, 43% (13 out of 30) of patients were able to self-prone for 6 or more hours a day. The median maximum prone duration per session was 2 hours. In the supine group, 47% (14 out of 30) were completely supine and 53% spent some hours in the prone position, but none exceeded 6 hours. There was no significant difference in any of the secondary outcomes between the two groups and there were no adverse events.

Monday, March 08, 2021

Dunkirk !

 I am watching a week by week recreation of WW2

In week 44, June 1940, Nazi Germany had overrun most of Europe, and USSR had annexed Eastern European countries.

The Netherlands and Belgium had surrendered to the Nazis in May, and France in June.

Dunkirk: 9 Lesser-Known Facts - HistoryExtra
Allied forces were beaten back to Dunkirk in France, just across the English Channel from Britain. To prevent their capture by the Nazis, a desperate operation was launched to rescue them via sea to take them back to England.

2 lakh british and 1.4 lakh mainly french soliders were rescued, but 0.8 lakh were left behind in Dunkirk (half of them British and the other half French) to hold off the Nazis while their compatriots escaped.

But all the equipment had to be left behind, desperately needed by Britain which now faced the Nazi war machine alone. The US had refused to be drawn in the war, despite British requests. 

The operation commenced after large numbers of BelgianBritish, and French troops were cut off and surrounded by German troops during the six-week Battle of France.

Winston Churchill, Britain's Prime Minister during World War II, called Dunkirk a "miracle of deliverance".

Initially it was thought the Germans would reach the beach within two days, allowing time for only 45,000 troops to be brought to safety.

But thanks to a combination of German confusion and Allied bravery, enough British and French troops were saved to see out the rest of the war.

After Nazi Germany invaded Poland in 1939, the British sent in troops to defend France. However, as Nazi Germany moved forward into Belgium and the Netherlands in May 1940, the allies made a near-fatal error.

The French-German border was defended by a series of barriers and weapons called the Maginot Line, but the area to the north was only blocked by a forest.

The forest was thought to be too thick to require heavy defence, but the Germans found a way through.

They marched around the back of the Allies in France and forced them over into Belgium, where they were faced with more Germans to the north.

The only option left was to retreat to Dunkirk, where they could be taken back to England.

With the majority of Britain and France's entire armies in one area - surrounded by the Germans - this could have been the turning point of the war. But Hitler ordered his troops to halt for three days. Attacking the trapped BEF, French, and Belgian armies was left to the Luftwaffe - Germany's air force. 

Evacuations from Dunkirk commenced on 26th May 1940, while 40,000 men of the French First Army fought a delaying action against seven German divisions.

The Allies were gifted with time. Naval ships, vehicles, passenger ferries, fishing boats, yachts and boats owned simply for pleasure were assembled.

A handful of civilians even joined the mission, sailing out into the Channel voluntarily.

Over the course of nine days this fleet, supported by British planes overhead, was able to rescue most of the troops.

Tuesday, February 02, 2021

29 % of Small Particulate Matter come from Trash Fires

The Main Takeaways from this Blog Post

  • In the world as a whole, 29 % of Small Particulate Matter come from Trash Fires.
  • Studies show that 8-15 % of small particles in Delhi's air are from trash fires.
  • All the noise about air pollution has not lead to appreciable reductions in Delhi's small particulate matter. It was down just 6 % in 2019 compared to 2018.
  • Despite construction and industrial activity, brick kilns and vehicles being completely shut down in the lock down period, particulate matter went down only by 30 %. This implies that household emissions, open burning, diesel generators and dust may together contribute some 70 % of the particulate matter in metros, apart from coal fired power plants.
  • A study from Ahmendabad also showed that the smoke from burning roadside trash piles can be at least as dangerous as the more obvious culprits, including vehicular pollution and pollution from factories.
  • Shortage of landfill capacity has consistently been touted as the reason to push for waste to energy incinerators in India. These have proven to be notorious sources of air pollution and highly toxic ash residues - their pollution being 14 times that from coal plants ! So if you dont compost your wastes, you eventually get highly polluting incinerators !
  •  It is estimated that (improper) waste management through landfills and biomass burning is the second biggest source of climate-damaging methane gas, after coal mining.
  • There is an association between mismanagement of solid wastes and 22 human diseases.

Trash Fires are a Serious source of Pollution

Residents and governments often burn piles of their trash in the open (or trash in dumpsites spontaneously keeps combusting because of generation of methane in anaerobic conditions) - removing the garbage from the land but transferring it to the skies. Some 40 percent of the world’s waste may be dealt with in this way.

In the world as a whole, as much as 29 percent of global anthropogenic emissions of small particulate matter that can penetrate deep into the lungs come from trash fires. About 10 percent of mercury emissions come from open burning, as well as 40 percent of polycyclic aromatic hydrocarbons. Such pollution can cause lung and neurological diseases, and has been linked to heart attacks and some cancers.

8-15 % of small particles in Delhi's air are from trash fires

IIT Kanpur study on Delhi in 2015 showed 7.5 % of the PM 2.5 concentrations in the air were from open waste burning (though some other studies show the contribution of open waste burning to be 15 %) - some eight times the contribution of industry !

Shutting down construction and industrial activity, brick kilns and vehicles brought down particulate matter by only 30 %

Particulate matter went down by 30 % in the four big metros of india during lockdown of 74 days. Out of the eight primary polluting sources in India, four were completely closed during the lockdown period — namely construction and industrial activity, brick kilns and vehicles.

During the lock down, power demand plummeted by 20 % due to a decline in industrial activity. Coal-fired thermal power plants are one of the key sources of air pollution in India. 

Sources like household emissions, open burning, diesel generators and dust were operational during the lockdown period - this implies that it is these sources that may together contribute some 70 % of the particulate matter in metros, apart from coal fired power plants.

This is an important pointer to show how open burning of garbage is a critical contributor to air pollution.

Another study has estimated that emissions from biomass and open burning of waste contribute to almost 20–30% of the total air pollution in cities like Delhi. 

The dumpsites are riddled with instances of dangerous methane discharge, incessant fire outbreaks and landfill slides.

If you dont compost wet wastes, you get highly polluting incinerators !

Shortage of landfill capacity has consistently been touted as the reason to push for waste to energy incinerators in India. These have proven to be notorious sources of air pollution and highly toxic ash residues - their pollution being 14 times that from coal plants ! The most lethal incineration emissions are dioxins and furans which are highly carcinogenic and persist in the environment.

Despite all the brouhaha, Delhi’s particulate matter is going down at an excruciatingly slow speed – it was down just 6 % in 2019 compared to 2018.

Burning trash is as dangerous as pollution from vehicles & factories

In the recently released issue brief on air pollution in Ahmedabad, the burning of trash gets a passing mention as a contributor to air pollution. It turns out that the smoke from burning roadside trash piles can be at least as dangerous as the more obvious culprits, including vehicular pollution and pollution from factories.

For instance, in tests conducted on samples of emissions from several garbage fires in Bengaluru found that somebody standing near one of these fires is getting a dose of toxins 1,000 times greater than they would from the ambient air.

A study in Nigeria found Levels of suspended particulate matter, Carbon Monoxide, CO2, and Methane within the vicinity of the dump site fires, were above regulatory limits. Dump site fires in the study area could threaten the health of anyone.

It is estimated that (improper) waste management through landfills and biomass burning is the second biggest source of climate-damaging methane gas, after coal mining.

Pollution from trash poses serious health risks

There is an association between mismanagement of solid wastes and 22 human diseases.

A study by Ganga Ram Hospital has revealed that 50% of the population of Delhi is at risk of contracting lung cancer even if they do not smoke. The Lancet Commission on pollution and health ranked India number one with 2.51 million deaths in 2015 due to pollution.

Friday, January 01, 2021

Recent Analysis of the new UK strain

I read up on the new UK and South Africa Covid strains. The growth rate of the UK strain is 71% higher than other variants. The viral load suggests 0.5 increase in new the new strain.

The viral particles in the infected individual may be higher, which leads to more replication inside the cells and people are likely to shed more of it onto others.

The R-value of the UK strain shows an absolute increase between 0.39 and 0.93, that is more than twice as much. The R value represents reproduction number and indicates an average number of secondary infections caused by an infected case.

The cycle threshold or CT value in the RT-PCR test suggests a decrease of about 2. Examining data from 18 studies, investigators found significant correlations between Ct values and severe disease. Viral load from the respiratory tract and plasma are associated with markers of disease severity and inflammation. But the College of American Pathologists has said that although specimens with lower Ct-values generally have more viral RNA than specimens with higher Ct-values, the quantitation and precision associated with those differences in Ct-values have not been determined.

Although there may not be much change in the symptoms and the mortality rates remain the same in the new UK strain, if the virus spreads more efficiently it may lead to increased hospitalisations, that strain the health systems.

India has 25 confirmed cases of the UK strain till Dec 31st and their contacts are also in isolation. As the UK strain emerged in Sep, there may be many more cases in India which have not yet come to light. 

The WHO calls for genomic sequencing from 1 out of every 300 confirmed cases to find out if there are mutations occurring in the circulating virus in an area. Until recently, India seemed to be doing 10 times less than that.

Sequencing was stepped up from 21st Dec for those UK returnees who were found to be covid positive. 

There is an effort to trace the 33000 passengers who arrived in India from the UK since nov 25th, and those they may have come in contact with. Tracking down people returning to India from the UK has reportedly been challenging for the authorities. As of 30th Dec, Pune, for instance, is yet to trace 109 travellers and Odisha has been given a list of 74 more people who could be possible carriers.

In Andhra Pradesh, the state’s Health and Family Welfare department has been able to trace 1,406 UK returnees out of the 1,423 identified, according to commission K Bhaskar.

So far, 114 of around 33,000 arrivals from the UK have tested positive for Covid-19, of which 6 are positive for the new strain.

Genome sequencing will also be conducted on all international passengers who were symptomatic and tested positive for coronavirus in the 14 days from December 9 to 22. 

5% of RT-PCR positive samples in the country will also be sequenced to find out what are other types of mutations that the strains circulating in India underwent.

5000+ sequencings in the last 11 months did not reveal any virus drift or shift in India. 

All those who have recently returned from the UK will have to undergo home quarantine for 28 days even if their RT-PCR report comesnegativeAs per the UP government’s advisory, those who test positive for the new mutant strain would be kept in an isolation ward.

Said K Vijayraghavan, the principal scientific advisor to the Indian government : “We must take extraordinary precautions to prevent these kinds of variants from dominating our population.”

Medical experts said that we need to ban all the international flights. Though flights from the UK are now banned, the virus strain could have spread to other countries and flights from other countries are still operational. All the precautions that were advised for covid-19 must be followed. No matter how the virus changes, it needs us to be close enough to each other and to have interactions to let it jump between us.

Meanwhile, the Centre has formed an expert panel to decide the criteria for selecting the 27 crore potential recipients of the Covid-19 vaccine after 1 crore doctors and 2 crore front line workers receive their vaccinations.

The 12-member panel comprising specialist doctors of kidney, lungs, heart diseases, and cancer would finalise the parameters based on which the recipients would be chosen. While age and comorbidity are the determining factors, the experts would also take into account the severity of a disease. For instance, mild hypertension being experienced by nearly 30% of Indians would not be counted as a comorbidity factor, but severe hypertension would be.

National Expert Group on Vaccine Administration for COVID-19 had recommended prioritization of the vaccine during the initial phases to health care workers, frontline workers, persons aged 50 years and above, and those below 50 years of age with comorbidities.

It was reported on Dec 28th that the health ministry said that more than 70 percent of the nearly 1.5 lakh covid deaths occurred due to comorbidities.

Brihanmumbai Civic officials are closelymonitoring the UK, West Asia returnees and their close contacts. Special arrangements have been made for Covid-19 positive patients among them at a hospital in Marol.

As many as 1,200 of 2,600 passengers, who have returned from the UK and West Asia to Mumbai from November 25 and December 28, have been tested. Many passengers are not coming forward to reveal their travel history or their close contacts.

The Ministry of Home Affairs said the States and UTs can impose local restrictions like night curfew to check the spread of COVID-19 but made it clear that they will have to consult the Centre before imposing a lockdown outside the containment zones.

Social, religious, sports, entertainment, educational, cultural, religious gatherings with a maximum of 50 percent of the hall capacity and with a ceiling of 200 people in closed spaces were allowed by keeping the size of the ground and space in view, in open spaces.

However, based on their assessment of the situation, the state governments may reduce the ceiling to 100 people or less in closed spaces, it had said.

Saturday, December 05, 2020

MSP exists only on paper

Since a better administered MSP is the central demand of farmers, I am reading up more about it. 

Farming today means farming with losses. This needs to turn into farming where hard work can produce savings instead of losses.

Before Elections BJP promised MSP 50 % above cost of production

In his election promises, Modi had on multiple occasions promised to implement the recommendations of the Swaminathan Commission on farmers and raise the minimum support price (MSP) offered to farmers to 50% above the cost of production.

The finance minister's budget speech of 2018 said that they were going to implement their electoral promise. Farmers movements had already exposed this to be a fraudulent claim. Finance Minister had admitted that the cost he was speaking about was not comprehensive cost but partial cost.

Why MSP is critical for India's farmers

Minimum support price is at the heart of the existing system to ensure fair and remunerative returns to farmers. MSP is a solemn guarantee to the farmers to the effect that the central government shall ensure the floor price should the farmers fail to get even that level.

The election promise was that the farmer will get an MSP which is 50% higher than his entire cost of production. But the BJP Govt. made it a partial cost: this differs from whole cost in the sense of whether the imputed rent of the farmer’s land is included in it or not. Every shopkeeper or landowner includes this in his cost – just because my father has land does not mean he bears no cost for holding that land. 

The MSP is meant to ensure that the sale price of agriculture produce will not fall below this minimum amount. But the reality is that ordinarily, the MSP becomes the maximum price for the farmer that only some farmers get. 

MSP exists only on paper

MSP is announced for 14 crops. Yet only two are actually bought by the government - only wheat and rice. For the rest, if you can sell them somehow, then that’s it.

Of all the rice produced in the country, the government buys one-third. Of all the wheat produced in the country, the government buys one-fourth. It buys 0.2% of all the bajra produced in the country. 

The MSP exists only on paper. The farmer comes ready with his crop and asks the government to buy it. The government says the arrangement does not exist in your district, the centre will open 15 days later here. Or it closed ten days ago and you’re late. Or you do not have the required paperwork.

India's agriculture goals have to put the farmer first

There is also a frequently made argument that productivity should be increased. In reality, today, we see surplus being the problem. The agricultural policy of India has always been production-oriented instead of being producer-oriented. That is the entire problem. The farmer is not affected by where your production levels have reached. The dilemma is that when production increases to such an extent, the farmer is killed.

We need an independent commission for agricultural costs

The farmer should get a legal guarantee for the MSP. The Commission for Agricultural Costs and Prices, which determines the price, is under the thumb of the government and is run by the yes-men of the ruling party. This should be made an independent, accountable commission, whose recommendations should be binding. Farmers should have the legal right to get at least the MSP for their produce. They should have the right to go to court, file a case and get compensation if they do not get the MSP.

For 13 years, the farmer has been denied 50 % MSP over his costs

Since 2014, Indian banks have written off nearly 7 lakh crore in unpaid loans. Just 2 % of these belong to farmers

Today the farmer is badly caught in debt. The farmer will have to be exempted from this debt one time. This is not pity or begging. For 13 years, the farmer has been denied the Swaminathan Commission recommendations. The arrears of 11 years turn out to be Rs 22,00,000 crore, the farmers’ loan is Rs 14,00,000 crore. Exempt them of this debt, so that the farmer can stand up.

Yogendraji asks, are farmers today the priority of the country, or are they not? This will determine whether the government has money in its pocket for them or not.

Nearly half of what we pay for Diesel, goes to the central government as excise

One of the comebacks to my farmer posts yesterday was from a neighbour who called to say that diesel was expensive as 'all the money paid by consumers went to Kejriwal.' I asked if he meant state governments in general, including BJP ruled UP, Haryana and Madhya Pradesh, which kept back most of the money from diesel sales in state taxes. 

He was forced to agree that all state governments did so. He added that center had no role in increasing prices, only the state governments did. Centre kept back very little of the taxes he said, the lion's share went to state governments.

I wrote back to him : Sir, kal aap ne kaha ki the high price that the farmer is paying for diesel is because of taxes by state governments. Not as per this detailed analysis in May this year

Fuel prices in India are currently one of the highest in the world. Every time the farmer (or the rest of us) buys diesel : 

# Nearly half of what he pays goes to the center.

# Nearly a third goes towards the actual price of diesel with small amount of freight and dealer commission.

# Nearly a quarter of the price goes to the state govt. as taxes. 

# Central govt. taxes are double that of State.

This gentleman who called with the diesel story is a leading light of the ruling party at the center. He is helpful in colony affairs and is affectionate. But I supposed he had to project his party's defence. 

That defence follows a familiar pattern - jumble lies with half truths and discredit whoever has a different opinion.. hope most people wont look up the facts and repeated over and over, your lie will become the truth in people's minds. 

That is how the lies about muslims, nehru family, even gandhi are being propagated day in and day out.. thanks to being on several groups i can see what the paid trolls churn out on a daily basis.. all lies.. 

All the forwards you hear and posted on these groups - taken from facebook pages which stock hundreds of lying stories.. are LIES paid for by the ruling party, via trolls. Award winning books have documented this phenomenon in detail. 

Take any of these stories and check it for veracity. i have done it dozens of times... all lies which you happily swallow.

So what is the lie being put out in the case of diesel and farmers ? That centre has no role in increasing prices - lie. 

Central Govt. is the only beneficiary of increasing prices along with state governments (in a smaller proportion). Neither the consumer nor even the oil companies are benefitting from decontolling the price of fuel in india. 

When price of oil goes down in the international market (like it did in most of 2020), central govt. does not lower prices in india - it slaps more excise duty and takes all the savings from oil purchase into its own coffers. this has been done atleast twice this year already. 

No benefit of lower international prices is passed on to indian consumers, including farmers.

Another lie is that only State Governments benefit from slapping taxes on fuel. 

Central Govt. takes twice as much of the fuel amount as tax as state government. 

Nearly half of what you pay at the petrol pump goes to the central government.

BJP's claims on protecting MSP will only be believed when it is part of the new law

 In this interview on the farm bills 2.5 MONTHS AGO, Yogendraji again clarifies:

# No Kisan sanghathan has ever asked for the provisions in these bills in the past many decades. # Even the RSS backed Kisan sanghathans are in opposition to the farm bills. # The Government did not consult a single kisan organization in the run up to the bills - it is in a tearing hurry, first passing ordinance and then these bills.. it is clear that the intent is not to benefit farmers, but some other objective. At about 4.15 counter, Yogendraji explains that the ability to stock as much as desired WILL NOT benefit farmers, but very large stockists who will find it easy to manipulate the market for farm commodities. Both farmers and consumers will lose out by such manipulation. At about 7.15 counter, Yogendraji talks about the bill impacting APMC mandis: # For a long time, farmers have been asking for improvements to the APMC Mandi system. # They have also been asking for APMC Mandis to be set up in large parts of the country where APMC Mandis dont exist at all. # But the Government has no response to what the Farmer organizations have been asking for. Instead, it says it will allow private players to set up mandis outside the existing APMC mandis. # The carrot to lure farmers to private mandis is that the 6-8 % tax currently charged at APMC Mandis will not be charged at private mandis. # This will lead to the APMC Mandis becoming dysfunctional in a few years. Once the APMC Mandis are dysfunctional, MSP will not be available to farmers. At about 8.30 counter, Yogendraji explains that if the govt. has farmers' interest at heart, it would create a level playing field between private mandis and APMC mandis : # Same MSP applicable at private mandis as in APMC Mandis. # Same taxes levied at the private mandis as in APMC Mandis. # Same registration of traders in Private mandi as in APMC Mandi. But the Government is not interested in these amendments as it has no interest in farmer welfare in these laws. They are meant for some other objective. At about 9.20 counter, Yogendraji explains that the loose talk about 'freedom for farmers' is a complete LIE. There is no restriction on farmers since 1975. Any farmer can sell his produce anywhere today also, before these bills were ever passed. The restrictions are not on farmers but on traders. And this game is being played to benefit traders and big business, not farmers. The restriction on traders is this : that trade in agricultural commodities is permitted only inside APMC Mandis (where they exist), as per the rules of the mandis. At 10.55 counter, Yogendraji explains that wherever in the country, APMC Mandis have been removed, farmers' situation has deteriorated remarkably. For example, in Bihar, a law was passed in 2006 (by the same NDA Government) to abolish APMC Mandis. Today all over the country, rice is sold by farmers at 1600-1700 while in Bihar it is sold at 1000-1100 Rs., he says. A study on Bihar last year said that “Farmers are left to the mercy of traders who unscrupulously fix a lower price for agricultural produce that they buy from [them].' The report concluded that 'Bihar’s repeal of the APMC system and consequent increase in price volatility could be one of the reasons for low growth of agriculture in the state.' At 11.40 counter, yogendraji explains that farmers dont want to opt out of the AMC mandi system. They want it strengthened. BJP's claims on protecting MSP will only be believed when it is part of the new law. Already there is not a single law in the country that ensures farmers get minimum support price for their produce. For example, the MSP for corn is 1760 but it is selling at 850-900 rs. a quintal in W Bengal and Bihar (when the interview was being recorded in Sep 2020). Once Minimum Support Price is enshrined in law, the farmers dont mind private mandis or laws for company contract farming etc. At about 14.10 counter Yogendraji explains that a model APMC act was created by the Vajpayee Govt. in 2003 at the center. States were requested to reform their acts in line with the central act to remove anomalies in the functioning of APMC mandis. But even State BJP governments since then did not adopt this model law. Today, crocodile tears are being shed at the centre that state governments have not adopted a model law - when it was the same party in power in most of them in the years past ! At 16.45 counter Yogendraji explains that most of the farmer organizations in Punjab protesting against these bills are not allied to either Congress or the Akalis - they have criticized both parties. At 19.45 counter, Yogendraji says that the talk of private investment in agriculture is laughable as all farmers anyway invest their own resources in farming. Agriculture in India is already in private hands - the farmers' hands. But the Government uses the term 'private investment' only in the context of big companies. The idea is to withdraw from government role in building warehousing, in providing minimum support price, and leave agriculture only to market forces. At 23.15 counter, the interviewer refers to the PM saying that the farmer can now sell his produce everywhere, even export it. Yogendraji responds with a sense of shame, that the 'the PM lies'. He asks to be shown the law in any Indian state that prevents a farmer from selling his produce anywhere - there is no such law anywhere. There is a restriction on exports, which is not dealt with by these three farm bills.
+++++++++++++++++ So what is it that the farmers are asking for ? That MSP be maintained and improved upon. That APMC Mandis be maintained and improved upon. How hard is that for a callous, uncaring Govt. to understand ? And how hard is that for us - the rich of this country, but still dependent on food grown by farmers to understand ? Subsidies to Farmers is a complex subject. Suffice to say that many countries around the world spend similar amounts as India in subsidizing farmers or even more, including Indonesia, China, Japan, US and the EU. Only New Zealand has done away with subsidies and continues to prosper in agriculture.