Covid in India: Missing facts, misdirected discourse

‘The current stentorian discourse sans facts, which shifts the blame on to the government for the supply chain failures of hospitals, misses a more critical fact. Anticipating a contingency like this, the Modi government had ordered 162 PSA plants at a cost of over Rs 200 crore in October last for government hospitals all over India. This could have produced 80,500 litres of medical oxygen per minute. This translates approximately to one ton of liquid oxygen per day per plant. 

‘But out of plants ordered for 162 hospitals, only 33 got installed. Why? Even state government hospitals thwarted the Centre’s plan for on-the-spot oxygen production facilities. The Print says, orders were placed in December but when vendors reached the hospitals for installation, many “faced resistance” from them, pretending “no space” — the real reason being vested interest to procure oxygen rather than generating the entire requirement onsite. This showed how advance planning for on-the-spot oxygen supply by the Centre was thwarted by even the state-run hospitals. In the contemporary shouting and counter shouting in the media and social media, has anyone heard about this farsighted move of the government, beyond the feeble voice of The Print?’

Read here (New Indian Express, Apr 27, 2021) 

Long Covid affects most hospital patients, two UK studies find

‘Most patients treated in hospital for Covid-19 are still suffering a wide range of symptoms five months after discharge — and middle-aged women are even more likely to have long Covid than other groups — according to two UK studies released on Wednesday.

‘The larger study, led by the University of Leicester and called Phosp-Covid, analysed 1,077 people discharged from hospitals across the UK and found that only 29 per cent were fully recovered.

‘The remainder had an average of nine persistent symptoms each. These covered a wide range, including muscle pain and fatigue, breathlessness, pain, joint pain or swelling, weakness, short-term memory loss and “brain fog”.’

Read here (Financial Times, Mar 25, 2021)

Sg Buloh Hospital: Lessons from frontline of country's main Covid-19 centre

‘Sungai Buloh Hospital (HSB) had been at the forefront of the fight against the Covid-19 pandemic since the day the virus was detected on our shores. Serving as the main dedicated Covid-19 centre, it has treated nearly 50,000 positive patients to date.

‘While the hospital had been successful in helping the country battle the outbreak, little is known about what has been happening behind the scenes, especially the struggles faced by frontliners who had dedicated their lives for the sake of their patients.

‘Malaysiakini spoke to HSB director Dr Kuldip Kaur (above) in an exclusive interview recently, during which she revealed some of the biggest challenges they faced.’

Read here (Malaysiakini, Mar 9, 2021)

Covid-19 cases are dropping fast. Why?

‘One month ago, the CDC published the results of more than 20 pandemic forecasting models. Most projected that COVID-19 cases would continue to grow through February, or at least plateau. Instead, COVID-19 is in retreat in America. New daily cases have plunged, and hospitalizations are down almost 50 percent in the past month. This is not an artifact of infrequent testing, since the share of regional daily tests that are coming back positive has declined even more than the number of cases. Some pandemic statistics are foggy, but the current decline of COVID-19 is crystal clear.

**Four reasons: social distancing, seasonality, seroprevalence, and shots.’

Read here (The Atlantic, Feb 17, 2021) 

Growing number of Covid-19 patients dying at home [in Malaysia]

‘In the first week of this month, 10 Covid-19 patients have died before they could receive treatment at a hospital. The youngest to suffer such a fate this month is an 18-year-old girl who was brought in dead at the Selayang Hospital, Selangor. Her infection was compounded by asthma. Her death was reported by the Health Ministry in its daily statistics yesterday.

‘According to Malaysiakini’s tracking, 22 people infected with Covid-19 were brought in dead in December last year. Another 41 people were brought in dead in January this year. That means since December last year, 73 out of the 512 recorded fatalities were brought in dead, slightly above 14 percent.’

Read here (Malaysiakini, Feb 8, 2021) 

Is govt doing enough about Covid-19? – P Gunasegaram

‘The warning to manufacturers by the International Trade and Industry Ministry (Miti) reported over the weekend raises very serious questions on the handling of the Covid-19 pandemic. According to reports, Miti is involved in 99 of the more than 300 Covid-19 clusters in the country. This makes the manufacturing sector the main source of Covid-19 infections. Also, Miti indicated that there would be a shutdown/strict lockdown if Covid-19 numbers did not improve...

‘First, if indeed manufacturing is the main source of infections – it is no secret that cramped living quarters are the main source of Covid-19 – why is there no public information on this? Why is the matter only between manufacturers and the government?...

‘There are other questions, too. With the rising cases and contact tracing, it should have been obvious that the hospital system would reach full capacity and be strained. Why was there not enough serious effort put in to ease the strain on hospitals? When did we know that hospitals were going to be strained? Why wait so long before we announce it and formulate measures to take care of that? Why did contact tracing break down? What do we do now? What is the alternative?...

‘And then, there is the matter of the vaccine. Why was Khairy Jamaluddin, minister of science, technology and innovation, appointed to lead our search and procurement of suitable vaccines? It should have been led by health authorities. Let’s get this right, because the success of Covid-19 containment finally depends on it. Why the seeming delay in getting our vaccine rolled out? Why is our vaccine not yet ready? Singapore has got theirs, even Ecuador and Indonesia have theirs.

‘But where is ours? Why is it later than others? Are we prepared to roll out the vaccines in time, or will it take till next year, when enough of us are inoculated? And, have all the concerns about vaccination been sufficiently addressed?’

Read here (The Vibes, Jan 26, 2021)

If it ain’t broke, don’t fix it — Musa Mohd Nordin

‘The data shows that the MOH is doing relatively well. The risk of a Covid-19 death per population n Malaysia is 1 per 50,000. This compares favorably against the Global average of 1 per 3,676.b It is worse in the UK and US, 1 per 700 and 781 respectively...

‘Despite the surging numbers of Covid-19 cases, the MOH infrastructure and services are holding up well and delivering good outcomes when compared to the US, UK and our southern neighbours. Therefore, if it ain’t broke, don’t fix it. It is in this context that the following suggestions are made:

1. The MOH should continue to operate with the 52 dedicated Covid Hospitals.
2. If these are inadequate to meet the current surge in Covid-19 cases, select private and government facilities can be transformed into dedicated Covid Hopsitals.
3. The concept and operations of Hybrid Hospitals should be avoided as much as possible. It compromises the Quality of Care, especially among the Category 4-5 patients, and the Safety of patients, HCW, other hospital staff and visitors, due to the real risk of nosocomial infection from this most transmissible coronaviruses.
4. The lay public is fast becoming very fearful of Covid and Hybrid hospitals and this has led to them shunning away from hospitals despite their need for regular hospital visits and review.
5. If they delay or miss their appointments, the management of Non-Covid illness eg NCD, Cancers, Immunization uptake, will be compromised.
6. The MOH has begun to decongest and create more empty General and ICU beds in Covid Hospitals by discharging Category 1&2 patients to Home Isolation with clear instructions on the use of Health Assessment Tools.’

Read here (Malay Mail, Jan 24, 2021) 

One in eight ‘recovered’ Covid patients ‘die within 140 days’

‘The University of Leicester and the Office for National Statistics found that out of 47,780 people discharged from hospital in the first wave, 29.4% were back in hospital within 140 days and 12.3% died. Covid survivors were three and half times more likely to be readmitted to hospital and die compared to other conditions.’

Read here (Metro, UK, Jan 18, 2021)

Prevalence and risk factors for delirium in critically ill patients with Covid-19: A multicentre cohort study

‘In this large, international cohort study of more than 2000 patients with severe COVID-19, acute brain dysfunction (coma or delirium) was more common and more prolonged than observed in other studies of patients with acute respiratory failure without COVID-19. Patients with COVID-19 also received treatment with sedatives for a prolonged duration: two-thirds of patients were given benzodiazepines and propofol for a median of 7 days. 

‘As a result of the COVID-19 pandemic, many ICUs were operating in resource-constrained environments, and despite demonstrated efficacy in previous studies, evidenced-based strategies, such as light sedation techniques, spontaneous awakening and breathing trials, avoiding benzodiazepines, early mobility, and family visitation, all occurred on fewer than 1 in every 3 days among patients with severe COVID-19. We found that risk of delirium among patients with severe COVID-19 was lower when benzodiazepine sedative infusions were avoided and family was present, whereas greater severity of illness and greater respiratory support was associated with a higher risk of delirium.’

Read here (The Lancet, Jan 8, 2021)

Readmission and death after initial hospital discharge among patients with Covid-19 in a large multi-hospital system

‘Although more patients are surviving severe coronavirus disease 2019 (COVID-19), there are limited data on outcomes after initial hospitalization. We therefore measured the rate of readmission, reasons for readmission, and rate of death after hospital discharge among patients with COVID-19 in the nationwide Veterans Affairs (VA) health care system...

‘In this national cohort of VA patients, 27% of survivors of COVID-19 hospitalization were readmitted or died by 60 days after discharge, and this rate was lower than matched survivors of pneumonia or heart failure. However, rates of readmission or death were higher than pneumonia or heart failure during the first 10 days after discharge following COVID-19 hospitalization, suggesting a period of heightened risk of clinical deterioration. Study limitations include the inability to measure readmissions to non-VA hospitals and an older, male-predominant study population, who may be at higher risk of severe manifestations of COVID-19. Public health surveillance or clinical trials focused exclusively on inpatient mortality may substantially underestimate burdens of COVID-19.’

Read here (JAMA Network, Dec 14, 2020)

Crisis standards of care: Lessons from New York City hospitals’ Covid-19 experience

‘The purpose of this project was to convene a forum in which critical care physicians from a number of hospitals across New York City could frankly discuss their experiences with implementation of crisis standards of care (CSC). The Johns Hopkins Center for Health Security, in collaboration with New York City Health + Hospitals, convened a virtual working group in October 2020 consisting of 15 New York City intensive care unit (ICU) directors.’

Major themes discussed and suggestions moving forward are contained in the 23-page report.

Read here (The Johns Hopkins Center for Health Security, Nov 24, 2020) 

US states that imposed few restrictions now have the worst outbreaks

‘Coronavirus cases are rising in almost every U.S. state. But the surge is worst now in places where leaders neglected to keep up forceful virus containment efforts or failed to implement basic measures like mask mandates in the first place, according to a New York Times analysis of data from the University of Oxford. Using an index that tracks policy responses to the pandemic, these charts show the number of new virus cases and hospitalizations in each state relative to the state’s recent containment measures.’

Read here (New York Times, Nov 18, 2020)

Sungai Buloh Hospital Covid-19 team gets global health awards recognition

‘The Covid-19 team at Sungai Buloh Hospital, Selangor has been recognised at the Global Health Awards (GLA) 2020 recently for its unwavering efforts to fight the pandemic. Health director-general Dr Noor Hisham Abdullah congratulated the head of Sungai Buloh Hospital Infectious Disease Department Dr Suresh Kumar, and Anaesthesia and Intensive Care Department head Dr Shaiful Azman Zakaria, as well as the hospital's Covid-19 team as a whole for the recognition.

‘According to the Global Health Awards website, the regional Asia-Pacific awards aim to recognise companies in a variety of regional and global markets that have maintained consistently high standards in delivering quality care and pushed the boundaries of delighting their customers at every stage and in every interaction.’

Read here (Malaysiakini, Nov 1, 2020)

Singapore researchers develop ‘smart mask’ that can monitor signs associated with Covid-19

‘Local scientists have developed an integrated monitoring system that can be easily attached to any face mask in order to monitor the wearer for health indicators associated with Covid-19. Sensors pick up skin temperature, blood oxygen saturation, blood pressure and heart rate - all of which are parameters associated with coronaviruses. Professor Loh Xian Jun, who is one of the scientists behind the invention, told The Straits Times on Thursday (Sept 10) that the inspiration for the system came around the circuit breaker period.’

Read here (Straits Times, Sept 10, 2020)

The new stability

‘I look for hope and find none, but I am not allowed to admit to total free fall. “Stronger together” say the screen savers on every screen in the hospital, the banners on the sides of the shuttle bus. What I’ll see in the coming weeks is just how much this isn’t true, how so many of our sickest patients are Black or Brown like you, “essential” and yet unprotected. I will see a 46-year-old Black man, infected with SARS-CoV-2, die instead from having a police officer kneel on his neck. I will see those who protest police brutality, though masked and mostly peaceful, tear-gassed and shot with rubber bullets. I will see unregulated corporate bailouts, record unemployment, record housing insecurity. I will see political polarization recast common-sense public health policy as liberal propaganda. I will see your death multiplied by 10,000, by 100,000, all those bodies, mothers and fathers, daughters and sons. I wish I could tell you how sorry I am, for my fear, for our nation, for what happens next.’

Read here (New England Journal of Medicine, July 17, 2020)

People have stopped going to the doctor. Most seem just fine

‘As stay-at-home orders ease and cities reopen for business, many doctors and hospital administrators are calling for a quick return of health care to pre-pandemic levels. For months now, routine care has been postponed. Elective procedures — big moneymakers — were halted so that hospitals could divert resources to treating Covid-19 patients. Routine clinic visits were canceled or replaced by online sessions. This has resulted in grievous financial losses for hospitals and clinics. Medical practices have closed. Hospitals have been forced to furlough employees or cut pay.

‘Most patients, on the other hand, at least those with stable chronic conditions, seem to have done OK. In a recent survey, only one in 10 respondents said their health or a family member’s health had worsened as a result of delayed care. Eighty-six percent said their health had stayed about the same.’

Read here (New York Times, June 22, 2020)

The pandemic broke end-of-life care

‘The first day the palliative-care doctors walked into the ICUs, Thomas [Jane deLima Thomas, the director of palliative care at Brigham and Women’s Hospital and Dana-Farber Cancer Institute] says, “we felt like tourists.” They were dressed in business casual, while their ICU colleagues raced around in scrubs and masks. But the palliative-care team—which includes physicians, nurses, chaplains, and social workers—found ways to integrate themselves. In the early days of the pandemic, when protective gear was scarce, no visitors were allowed. Palliative caregivers, along with ICU nurses, held iPads cocooned in plastic bags so families could say goodbye on Zoom. They were sometimes the only one in the room when a patient died, otherwise alone. I interviewed several members of the Boston-based palliative-care team, and their stories, which have been condensed and edited for clarity, are below...’

Read here (The Atlantic, June 16, 2020)

I'm an ICU doctor treating coronavirus patients. But somehow I'm not angry

‘Sometimes I wonder if my lack of anger means I don’t care enough; if I’ve been worn down by ventilators being turned off, patients dying, families asking for a final call. Perhaps emotions overwhelm and suffocate each other in such a situation, leaving no air for something as indulgent as anger. Perhaps my anger couldn’t compete with the humility of knowing that until early March, I and every doctor I knew had predicted that this virus posed little threat beyond a bad seasonal flu. Like my better judgment, perhaps my anger had lost.’

Read here (The Guardian, June 11, 2020)

A pulmonary physician on what it's like to treat Covid-19 patients

‘I did not think much about my risk. Doctors are always at some risk of contracting a disease. However, that changed when I was exposed to a COVID-19-positive patient without my personal protective equipment for a considerable period of time and in close proximity. I questioned my "recklessness" in examining the patient (who did not exhibit any COVID-19 symptoms) and my ability to infect my family and other patients. I felt guilty and foolish for putting myself and my family in such a position. It was not a good day. One of my colleagues had even written a living will, just in case.’ 

Read here (Asia Society, June 3, 2020)

Coronavirus: 'Baffling' observations from the front line

“It felt in some ways like we were trying to prepare for the D-Day landings," says Barbara Miles, clinical director of intensive care at Glasgow Royal Infirmary, "with three weeks to get ready and not a great deal of knowledge about what we would be facing". But what arrived in the UK as winter turned into spring took even the most experienced ICU specialists by surprise. Most people infected with the coronavirus have only mild symptoms, or sometimes none at all. But in many thousands of patients who fall critically ill, Covid-19 is a disease of alarming complexity.’

Read here (BBC, May 23, 2020)