[joe1980]

Originally Posted by Nalin1

Can somebody explain why is it suddenly called second wave or third wave? The number of detected cases (actual may be far more) may increase and decrease with the number of tests conducted or any other medical reason. But the fact is that the virus is very much around and will be for the foreseeable future. So how does it matter really if it is second/third/fourth wave?

That's in the nature of a wave where there is a crest and a trough! So if you look at the graph of infected cases (irrespective of the tests of whatever), you can see the crest and a trough! One reason could be that there was a lock down and this helped bring the cases down, but the virus was still around leading to a trough. Once the lock down was lifted, the number of cases started to rise leading to a crest!

[Thad E Ginathom]

Your post/quote is so true, but a little light-heartedness might be allowed at this not-so-good wording...

Originally Posted by am1m

[url] Maybe a person feels so confident in the disinfection methods around them that they eat indoors without a mask, despite the much more substantial known risks."

Originally Posted by DCEite

I don't know who spread this fake news about surface contamination as the main mechanism by which Covid spreads, back in March/April. Was it WHO or CDC or Dr. Fauci ?

None of the above. I don't believe anyone suggested it was the main mechanism. That has long been thought to be respiratory/contact-with-mouth/eyes.

However, survival of virus on surfaces, and transfer by touch to face, and dangers thereof is under continuing research.

Originally Posted by Nalin1

Can somebody explain why is it suddenly called second wave or third wave? ...

My personal theory is that the world's politicians prefer to have it split up so they don't have to admit that, whilst there may be peaks, seems to me personally, that first wave never went away.

World situation: USA never got a got a grip and it shows. UK only a little bit. Some European countries seemed to get it under control. But the situation for those places seems a lot less optimistic now. India seems to have reason for optimism, so long as we don't blow it by thinking we no longer need to worry.

[Zen2001]

Originally Posted by vivek95

Hello Doc
I completely agree with you on the small scale trials backing up the approval of Remdesivir. No doubt, you have been sharing high quality posts since long time and your reply to my last one was spot on. I did read that yesterday and "thanked" it too. Thought of replying today but cannot see it now.

Thanks Dr. Vivek. I'm only endeavouring to highlight how (even educated) people can be (and are being misled) by "tweaked" data. The old adage "ignorance is bliss" probably is most useful here. My reply was deleted, but has the post has been un deleted and restored graciously by the mods now. Wish we could un delete some of the reality going around though! Thanks anyway.

Originally Posted by vivek95

My individual experience has been a mixed bag too, however it isn't of much significance compared to a large scale systematic ramdomised controlled trial conducted at 400 hospitals in 30 countries. My intention was to only share a latest update on the US-FDA approved drug, being fully aware that the three trials I have listed are nowhere as big as SOLIDARITY. I better had mentioned the sample size comparison, my apologies. Thanks for your perspective and I agree with everything.

I appreciate all individual and collective experiences and there's no doubt that there is a lot of variation in response to the same situation in different parts of our country. It just reflects how badly organized the medical system is (inspite of having the best brains around) and why Indian research has so limited credibility in the US and UK (from my personal experience here in the NHS).
Inspite of having the best in terms of sample size and diversity of population to conduct robust trials, it's pathetic to see what we have come up with, as compared to much smaller countries. This is not just my perspective now, but the sad reality. Anyway, it is what it is.

[Zen2001]

Originally Posted by am1m

https://www.wired.com/story/its-time...ial-type=owned

It’s Time to Talk About Covid-19 and Surfaces Again

"But in the hazy panic of the time, many people had already taken up fastidious habits: quarantining packages at the door, bleaching boxes of cereal brought back from the store, wearing hospital booties outdoors."

"Worrying about the small stuff exhausts people from focusing on things that do matter. There are all sorts of ways to imagine what might go wrong. Maybe a person feels so confident in the disinfection methods around them that they eat indoors without a mask, despite the much more substantial known risks."
But the best advice for breaking that object-to-nose chain, according to all the health experts I spoke with: Wash your hands."

It's only two precautions about what I'd being saying right from the beginning.

1 .Use your COMMON SENSE and avoid UNNECESSARY overcrowding

2. DON'T TOUCH YOUR FACE WITHOUT WASHING YOUR HANDS

Unfortunately, EVEN TODAY, neither of these is being followed. We just have to wait for the testing to stop to declare the pandemic as over.

Originally Posted by PearlJam

Thanks for your viewpoints, vivek95 and Zen2001. Just goes on to show how the so called drug trials work. There are so many instances of flip flops.
Under the garb of throwing around terms like 'peer review', 'randomized controlled studies', etc, these agencies change their viewpoints and conclusions at will, even putting our politicians to shame .

But wouldn't you think someone as credible as Fauci wouldn't see through this game of shiftingng goalposts during a trial in order to show a statistically significant outcome of the concerned variable? Clearly, politicians have not been put to shame; they have been hand in glove all along (not just during Covid19) when it comes to big pharma trials/patents. You can Google lawsuits involving the who's who of pharma worldwide and there's not one name you won't find there. Our Indian agencies - ICMR, DGCA, NPPA are all just bench warmers.

Originally Posted by PearlJam

But when an alternative system of medicine comes up with something, these people reject it outright, without a second glance, saying 'there's not enough scientific proof', 'it's not conclusive', 'we cannot really say for sure', etc.
End of rant.

If by this, you were referring to Baba Ramdev's trail of Coronil, it was an even bigger joke than any conventional trial. Read about how biased the case - control selection process was. 99% of the cases would have recovered without doing anything, apparently. What's sad is that they missed the opportunity to get their scientific credibility back inspite of having a good shot at it. And shifting the objective from "finding a 100% cure for the Corona virus to just finding an immunity booster" did not help the cause at all.

[Cessna182]

Originally Posted by PearlJam

Thanks for your viewpoints, vivek95 and Zen2001. Just goes on to show how the so called drug trials work. They touted plasma therapy, then rejected it. There are so many instances of flip flops.

Under the garb of throwing around terms like 'peer review', 'randomized controlled studies', etc, these agencies change their viewpoints and conclusions at will, even putting our politicians to shame

But when an alternative system of medicine comes up with something, these people reject it outright, without a second glance, saying 'there's not enough scientific proof', 'it's not conclusive', 'we cannot really say for sure', etc.

End of rant.

Even 1 person getting affected in a trial is a big deal because when replicated to billions, it would mean a few hundred thousands could be affected.

As for alternative medicine, a China professor got a nobel recently for some discovery. If explored well, India could easily get a few nobels for treatments from Ayurveda characterized by scientists.

Sadly, if you know any scientists you'd know already, things are grim. Scientists are disallowed from purchasing even basic stuff from abroad. How can you do research if you can't get sterile slides? And it is not their fault that manufacturers who supply to corporates in India do not have the standards fit for R&D. I know this because I worked in the field.

But of course. No one cares. All is well. We are Atmanirbhar. Meanwhile, the fish being cooked for Parliament folks comes from Vietnam

[Zen2001]

Originally Posted by poloman

I think looking back the actions like a strict lock down followed by a opening up have made much more sense looking back now.

Absolutely not. Lockdowns don't decrease mortality, they only postpone it (by climbing the peak slowly) and thereby prolong the overall duration of the pandemic. This has been predicted in several models (yes, taking into account the uniqueness of India) all over the world.

Originally Posted by poloman

The death rate is the lowest among major population countries. Better treatment protocols are in place and hospitals are not overwhelmed even when there was a major spike in case. This from my own experience of my mother's case.

Glad that your experience was not so bad. However our lower death rate is purely a due to our population demographic - just 18% over 55 as compared to 35-40% in the same age bracket in developed countries. Add the fact that co morbidities as a whole are drastically lower in our younger population as compared to an older population in the West. These 2 factors are the strongest indicators of covid19 mortality. What is interesting (and what the government won't tell you) is that in fact India has had the most deaths in an apparently younger population as compared to the same age bracket in the West. Digest that.

Originally Posted by poloman

Old population was not left to die like in some other countries. All this with limited resources and infrastructure..

That's just exaggerating. Deaths in nursing homes occur regularly worldwide; is just the way the press highlighted then this time. For instance, what they didn't tell you was that 75-80% of the nursing home population in Spain and Italy had major problems -cardiovascular, pulmonary, renal and even advanced cancer - and their life expectancy (in march) was 3 to 6 months anyway.
In 75 years, if our government can't have basic health resources (while almost everyone has mobile phones), we shouldn't be applauding this inefficiency.

Originally Posted by poloman

The govt had received major brick bats on this forum and atleast we should start giving credit where it is due. If we are able to avoid a second wave around festival season and get a vaccine handy in next 3 months I would say as a country, we have tackled the situation exceedingly well.

The government has been fortunate to get away with murder simply because there is no political opposition. The entire pandemic has been shabbily handled at every level (from ICMR/MOHFW to the local municipality/gram Panchayat levels) with knee jerk responses and a headless chicken like attitude. Sad to see people not realising this.

[Zen2001]

Originally Posted by am1m

I'm sorry, but credit for what?!
Even after all that has happened do we think the lockdown we had was a success?!
The death rate has stabilized Not because of anything that the government has directly done. In fact, most governments would have done better supporting the doctors and the hospitals in the initial days instead of trying to control them centrally and even shutting down private hospitals- like we did so many!
Yes, now the situation and the messaging the government is giving out is much better. But that could have happened much earlier, and this is not just hindsight, as far back as April-May, there were several doctors saying so. It took the government this much time to realize what needed to be done, and more importantly, what not to do.
So yes let us give credit to the doctors, nurses, and healthcare professionals around the world who have done their jobs spectacularly well in spite of government interference!

Totally agree, not just because I'm a doctor. Governments (worldwide) would have done much better to leave the experts to handle the situation or atleast listen to them!
Reminds me of a real life incidence during my surgical training - One of our trainee surgeons, who was quite incompetent (to put it mildly), somehow passed in his 3rd attempt and went to our head of dept offering sweets and saying "Sir, I passed because of you". I couldn't believe my ears when Sir nonchalantly quipped back " No, not because of me, you passed INSPITE of me"!

Originally Posted by bhushan08

At the time of early COVID fear (mar - Apr), lockdown was considered to be on the most viable strategy across the world (possible exception Sweden). The choice was b/w lives and livelihood.
With the benefit of hindsight, what would we have done if we were in the same decision making situation in April?

Here is what I think:
1. Lockdown with an explicit end timeline
2. Goals on what lockdown was meant to achieve .

In a way, this implies that Sweden didn't value lives inner livelihood. Not true though. They didn't gamble on the decision (unlike the UK, which was the main culprit to release the fear worldwide) either. It was a accurately calculated epidemiologic decision taking all factors into account. I had even attended a webinar conducted on the differing strategies of different countries in April. Sweden had already calculated their mortality till march 2021, and had found no significant benefit to be gained from a strict lockdown (except for their nursing homes) in terms of preventable deaths. Balance that with the economic losses that would be inevitable, claiming some more lives in the bargain.

As you said about explicitly timed lockdowns, it has already been proven that a 6 week lockdown was the most that was ever needed. If you needed anything more, you were already losing that race. It's that simple.
Also as you said about the goals; we failed miserably to organise our resources. Instead chose to remain in hiding (like cockroaches?)

[Samurai]

Originally Posted by Cessna182

Sadly, if you know any scientists you'd know already, things are grim. Scientists are disallowed from purchasing even basic stuff from abroad. How can you do research if you can't get sterile slides? And it is not their fault that manufacturers who supply to corporates in India do not have the standards fit for R&D. I know this because I worked in the field.

But of course. No one cares. All is well. We are Atmanirbhar. Meanwhile, the fish being cooked for Parliament folks comes from Vietnam

Well, nothing has since I posted the following back in 2015.

Originally Posted by Samurai

Outdated Customs policy
We live in a global economy where any product consists of components from multiple countries. But our customs department still labours under the assumption that any imports are bad. Why is this important? Any new research is not done from scratch, but it is built upon existing technology. If you want to create new technology, you need best of equipment, and best of components. If you are in business friendly country like US or Singapore, you can source equipment from various countries within days and go about your job. This is not possible in India. My company is part of a venture where we are trying to build a cutting edge equipment, which needs parts from China and Europe. We provide the computational support and an unit in West Bengal does the core R&D. Most of the time, the R&D team is fighting with the customs over shipping manifest, what is the worth of each item, etc. Often the parts spend many months in the customs warehouse. Meanwhile, the researchers have to be paid salaries to twiddle their collective thumbs.

[proton]

Originally Posted by Zen2001

As you said about explicitly timed lockdowns, it has already been proven that a 6 week lockdown was the most that was ever needed. If you needed anything more, you were already losing that race. It's that simple.
Also as you said about the goals; we failed miserably to organise our resources. Instead chose to remain in hiding (like cockroaches?)

Excellent post, Doctor! I'm not a medical professional, but I read an article that said a 6 DAY lockdown was all that was needed. The initial caseload was KNOWN to be between 1000-2000 infected patients, mostly incoming passengers from abroad, and this recommended lockdown period was sufficient to trace, track and quarantine/isolate them and their immediate contacts. In other words, lockdown without testing and tracing is useless. You must do those two steps.

Even tiny third, no, fourth world countries were able to do that. The fact is that our government ignored the recommendations of both our own as well as world epidemiologists, in ordering a 21 day lockdown, a primordial, last resort, crude, single step, effort to tackle the situation. Cities were surrounded and no exit was permitted by an army, till the disease disappeared, in MEDIAEVAL times. Ironically, this method, done sloppily, caused unnecessary damage to the economy and the livelihoods of millions, leading to movement of migrant workers, in turn exacerbiating the spread of the virus!

[PearlJam]

Originally Posted by Zen2001

If by this, you were referring to Baba Ramdev's trail of Coronil

Definitely not. My rant was about Ayurveda (and maybe other systems from other countries) in general, receiving step motherly treatment due to pressure from big lobbies. Some of these systems have existed and survived for centuries, and you can't call all of those patients gullible. Costs of healthcare today have gone through the roof, and the poor cannot afford it even for simple ailments. Hence they seek succour in those systems. Of course, it didn't help that rotten apples in those systems have destroyed the credibility of the whole system. Don't want to go anymore offtopic from Covid-19!

As a layman, do you agree or not, that there have been so many flip flops on Covid treatments and drugs? Do you agree that all the agencies that Zen2001 mentioned in an earlier post, have caused a lot of confusion in the minds of the people, and also medical practitioners? Do you think that their credibility today is good enough? Do you think that big lobbies are fudging clinical trials? Do you agree that inconvenient data are sometimes suppressed in these trials? Do you think that ethics of some of these agencies are above board? Do you agree that many treatment options that were "approved" after so called trials, have been discontinued due to adverse affects? Then pray tell me, how did they get approved in the first place? Do you agree that fatality due to adverse drug reactions are very high today?

I know that in a complex system like the human body, we still don't know many things. Exactly the reason you cannot thrash other credible voices.

I don't know the solution. There are good brains to figure it out. But it doesn't need a scientist to see that some of these systems have broken badly, and need a good relook. I am sure each of us know many friends/relatives who have had terrible experiences with hospitals today, side effects, as well as adverse drug reactions from cocktails of drugs. Simply asking someone to register for a class is a convenient way to maintain status quo and console ourselves that the current system of trials is perfect.

[proton]

Originally Posted by PearlJam

Definitely not. My rant was about Ayurveda (and maybe other systems from other countries) in general, receiving step motherly treatment due to pressure from big lobbies. Some of these systems have existed and survived for centuries, and you can't call all of those patients gullible.
.....
I don't know the solution. There are good brains to figure it out. But it doesn't need a scientist to see that some of these systems have broken badly, and need a good relook. I am sure each of us know many friends/relatives who have had terrible experiences with hospitals today, side effects, as well as adverse drug reactions from cocktails of drugs. Simply asking someone to register for a class is a convenient way to maintain status quo and console ourselves that the current system of trials is perfect.

Sorry, Pearl Jam, but I agree a little study of scientific methods would be very helpful in not spreading misinformation. The issue is more complex and nuanced than we can immediately understand, because there are differences between verifiability, the old scientific method, and falsifiability, which scientists now adopt.

[PearlJam]

Originally Posted by proton

The issue is more complex and nuanced than we can immediately understand, because there are differences between verifiability, the old scientific method, and falsifiability, which scientists now adopt.

Definitely it's a complex issue. All the more reason to invite various other credible opinions and voices that differ from the current system, don't you agree? I am definitely not saying that "I" am that voice. I'm saying, don't discredit "those" voices, using exactly the dismissing kind of terms you've used above. That is exactly the problem today.

I'm also repeating, that the current system has a lot of shortcomings. If you think that the current system of trials is perfect, and should be totally immune to criticism, then we have reached the end of the road and knowledge.

Especially in the Covid-19 situation, we definitely need different experts, not necessarily from one system, to come forward, so that their points of view can be verified, cross examined, debated, and comprehensively questioned by others. Just don't dismiss it outright.

Also, you could also give your opinions on the questions I asked in the previous post.

[proton]

Originally Posted by PearlJam

Definitely it's a complex issue. All the more reason to invite various other credible opinions and voices that differ from the current system, don't you agree? I am definitely not saying that "I" am that voice. I'm saying, don't discredit "those" voices, using exactly the dismissing kind of terms you've used above. That is exactly the problem today.

I'm also repeating, that the current system has a lot of shortcomings. If you think that the current system of trials is perfect, and should be totally immune to criticism, then we have reached the end of the road and knowledge.

Especially in the Covid-19 situation, we definitely need different experts, not necessarily from one system, to come forward, so that their points of view can be verified, cross examined, debated, and comprehensively questioned by others. Just don't dismiss it outright.

Also, you could also give your opinions on the questions I asked in the previous post.

Points noted. I promise I will answer your queries eventually, but we have to establish some basic rules. Can you agree to follow a rational basis for your statements? For example, saying something has been around for a long time is not a rational statement. Sometimes, cures work because of other factors, of psychosomatic effects, belief, hope. That's why scientists use the randomised double blind methods.

Let's first establish why cures are regularised, allowed. Please answer this:

How is a cure, treatment or medicine passed in the scientific community?

[am1m]

Originally Posted by proton

Excellent post, Doctor! I'm not a medical professional, but I read an article that said a 6 DAY lockdown was all that was needed.

In my humble (and quite obviously non-medical) opinion, I think that 6-day conclusion is with the benefit of hindsight. Personally, I think the initial lockdown (for whatever duration) was unavoidable and the only thing any responsible government could do. As far as I recall, no country in the world knew exactly what needed to be done at that time. Sweden was considered crazy for their strategy.

The problem was just implementing lockdown without, as you correctly said, testing or tracing, and then continuing to extend it even after it became pretty obvious that it wasn't working.

Overall, I think the main issue was that most governments, and this is all over the world (barring Sweden), tried law-enforcement tactics to solve a medical issue. Most politicians (again, this is across countries and parties) thought they knew better than the medical experts and didn't listen to them.

[Chetan_Rao]

The scientific community doesn't exist in a vacuum. They're monetarily and operationally dependent on entities that may and often have motivations other than public health. In case of a pandemic, potentially entire governments who want to appear a certain way, or corporations that want global first-mover advantage on profits.

It would be easy to say they should just quit if they don't like their working conditions, but that brings us back to square one, because a solution still needs to be found before it can be monetized for profit or leveraged for other reasons, and it needs capable people to do it, not just money and intent.

The scientific method is a slow arduous process with many pitfalls, false positives/negatives, dead ends and a whole lot of rework. It's based on evidence, observation and constant course correction. The reason the scientific community currently appears to be 'flip-flopping' is because they're being made to follow the full process in the glare of publicity, every detail scrutinized by people who neither understand context nor appreciate the entirety of what goes into creating something like a vaccine from scratch, for a pathogen that isn't even properly understood yet, and is constantly evolving. Everyone with a voice is an expert now, and uses that voice to denigrate the same people we're counting on to deliver a solution, because our unrealistic expectations aren't being met.

It's like getting nine women pregnant to deliver a baby in a month, then blaming it on the women when it doesn't happen. Some processes cannot be accelerated no matter the resources thrown at it.

A well-researched, properly-vetted and extensively-trialled public health solution cannot, and more importantly should not be fast tracked, because I'll bet my bottom dollar neither the corporates, nor the politicians nor even the general populace will take responsibility if a rushed process leads to a disaster. We'll just blame the 'experts' who we pushed into doing something they knew wouldn't hold up to proper scrutiny, and use that as a cudgel to push anti-intellectualism further.