Post Publication Independent Reviews COVID-19
Table of Contents:
Humble Thanks to His Excellency Hon'ble Dr. Harsh Vardhan, Union Minister for Health & Family Welfare, Science & Technology and Earth Sciences, Government of INDIA
for reciprocating (within 240 seconds, amidst the COVID-19 National containment & treatment protocols) the communications titled "A faint beam of light at the end of the tunnel.... ", which is a continuous set of Post Publication Independent Reviews of Research Articles on COVID-19, submitted to the Govt. of INDIA
1. Screenshot (below)
2. Copy of Communication as pdf file (below)
Humble Thanks to His Excellency Hon'ble Shri Narendra Modi, Prime Minister of INDIA
@narendramodi @AmitShah @drharshvardhan
Respected Prime Minister
Submitted to your esteemed attention please.
Prabhu Britto A.
Thanks to The Prime Minister, The Cabinet, The Secretaries & Officials of the Govt. of INDIA. Ref: COVID India Seva
@narendramodi @AmitShah @drharshvardhan
Respected Prime Minister
Heartfelt Thanks from The IJBST Journal Group, The Patrons, The Visitors, The Presidium, The Board & the Editor
https://www.facebook.com/MyGovIndia/posts/2923020227812147 April 22, 2020
https://twitter.com/PrabhuBritto/status/1249341067259867136 April 12, 2020 (link to content on this webpage at https://www.prabhubritto.org/post-publication-independent-reviews-covid-19#h.p_dRCUp17hoZBG )
Acknowledgement for Invitation from National Digital Library of INDIA to upload the Post Publication Reviews of Research Articles on COVID-19
Ref: Email Invite from National Digital Library of INDIA (Apr 26, 2020, 2:12 PM)
A HUMBLE NOTE OF THANKS
The IJBST Journal Group, The Patrons, The Visitors, The Presidium, The Board & the Editor are immensely happy to thank
Their Excellencies The Hon'ble
Shri Narendra Modi,
Shri Amit Shah,
Dr Harsh Vardhan,
Shri Ramesh Pokhriyal Nishank,
The Secretaries & Officials of the Govt. of INDIA
The National Digital Library of INDIA (NDL) &
The Scientists, Professors, Librarians, Administrators & Officials of NDL
for their esteemed invitation to upload to the NDL, the Post Publication Reviews on COVID-19 done by the IJBST Journal Group.
We are humbled by the aforesaid invitation. The Board of the IJBST Journal Group has been appraised and all Post Publication Reviews on COVID-19 done by the IJBST Journal Group till now and those that will be done hereafter, will be uploaded to NDL.
It encourages us to continue to serve, though against odds... & we shall continue to serve…
Signed this day, the 26th of April 2020,
For & On Behalf of the IJBST Journal Group
Prof. Dr. Prabhu Britto A., Founding Editor, IJBST Journal Group
Acknowledgement filed for the "Bold Reforms" Announcement.
and S. No. 31 at https://www.ijbst.org/covid-19-post-publication-reviews
Twitter Communications (Spreadsheet)
Post Publication Reviews
Part I. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Viral dynamics in mild and severe cases of COVID-19" Published: March 19, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30232-2
Publons Review Link:
A faint beam of light at the end of the tunnel....
Post Publication Independent Review of
"Viral dynamics in mild and severe cases of COVID-19"
Yang Liu, Li-Meng Yan, Lagen Wan, Tian-Xin Xiang, Aiping Le, Jia-Ming Liu et al.
Published: March 19, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30232-2
1. Title inappropriate. Mild & Severe has been classified by the Authors later in the Manuscript. No Universal Standard has been cited. Consequently, authors need not have included the keywords mild and severe in the title, for the reason that these are the first few research articles that are appearing on COVID-19. Authors cannot enforce Mild and Severe conditions so early. Else, they should have indicated subjective conditions in the title instead of generic objectivity.
2. Authors declare COVID-19 as a new pandemic disease in the first line of the manuscript. Citation required. Else, they could have substantiated in the manuscript that it is a pandemic. Heightening human anxiety in the first line of a research manuscript may amount to author bias.
3. In the second sentence of the manuscript, authors are disclosing the information that they had previously published on SARS-CoV-2. Was there any urgent necessity for the authors to declare to the scientific community that they have previously published on SARS-CoV-2 and they are now publishing on COVID-19. Do the authors intend to indicate that they are an authority on the area and related areas and consequently all that they publish needs to accepted as it is? When any simple search on Google.com or Google Scholar or any other internet search engine can throw light on the previous research exploits of the authors, why is there a necessity for the authors to indicate that they have published on SARS-CoV-2, right in the second sentence of this manuscript. Again, this might amount to author bias.
4. This manuscript has been declared as published on March 19, 2020. In third sentence of this manuscript, authors are citing Reference 3 with DOI:10.1056/NEJMoa2002032. Cited article is Clinical Characteristics of Coronavirus Disease 2019 in China
List of authors. Wei-jie Guan, Ph.D., Zheng-yi Ni, M.D., Yu Hu, M.D., Wen-hua Liang, Ph.D., Chun-quan Ou, Ph.D., Jian-xing He, M.D., Lei Liu, M.D., Hong Shan, M.D., Chun-liang Lei, M.D., David S.C. Hui, M.D., Bin Du, M.D., Lan-juan Li, M.D., et al., for the China Medical Treatment Expert Group for Covid-19*
Extract from cited article:
medical records and compiled data
as reported to the National Health Commission between December 11, 2019, and January 29, 2020; the data cutoff for the study was January 31, 2020
4a. Did the National Health Commission certify that the data reported is error-free? Is National Health Commission Certification attached to cited manuscript DOI:10.1056/NEJMoa2002032 ?
4b. Attention is drawn to https://www.worldometers.info/coronavirus/country/china/
(i) Jan 31, 2020:
Total Cases: 11,791.
Daily New Cases: 2,099.
Active Cases: 11,289.
Total Deaths: 259
Daily New Deaths: 46
Newly Infected vs. Newly Recovered: 2,099 vs 72
Outcome of Cases (Recovery or Death): Recovery rate vs death rate: Not Available
(ii) Peak Rates:
Total Cases: 81, 218 as on 25.03.2020
Daily New Cases: 14,108 as on 12.02.2020
Active Cases: 58,016 as on 17.02.2020
Total Deaths: Gradient of curve indicates gradual slope upto Feb 16, further becoming more gradual until Feb 22, and growing still more gradual post Feb 23.
Daily New Deaths: Peaks observed at Feb 12, Feb 14, Feb 15, Feb 18, Feb 23. Graph is not steady. Waxing and Waning nonsystematic.
Newly Infected vs. Newly Recovered: New Cases Peak at Feb 12. New Recoveries Peak at Feb 27. Also noted that Lowest Recovery does not coincide with New Cases Peak and Lowest New Cases does not coincide with Peak New Recoveries. Nonsystematic behaviour observed.
(iii) Total Cases as on 25.03.2020: 81,218
Quote "As of February 25, 2020, a total of 81,109 laboratory-confirmed cases had been documented globally.5,6,9-11" End of Quote
Quote "We obtained the medical records and compiled data for hospitalized patients and outpatients with laboratory-confirmed Covid-19, as reported to the National Health Commission between December 11, 2019, and January 29, 2020; the data cutoff for the study was January 31, 2020" End of Quote
Did the authors draft the article after Feb 25, 2020, coz there is no possibility that they can include a futuristic statistic as globally documented data. Consequently, this manuscript should have been drafted after Feb 25, 2020. If this manuscript has been drafted after Feb 25, 2020, why was the data cut off for the Study fixed as January 31, 2020?
Quote "Written informed consent was waived in light of the urgent need to collect data. " End of Quote.
Read together with http://www.icmje.org/icmje-recommendations.pdf, when written informed consent itself was given an allowance and bypassed, then except for the data of the last few hours, the rest of the data would have been available even upto Feb 25, 2020 (minus a few hours, perhaps upto Feb 24, 2020).
Attention is drawn to the phenomena observed under 4b (i-iii), it raises a question whether some very significant clinical information has been left out? If so, what would be the significance of the outcome of the results of such a manuscript which is suspected to have left behind very significant clinical information?
4d. Attention is drawn to Article Metrics https://www.nejm.org/doi/metrics/10.1056/NEJMoa2002032
Social Media seems to have been enchanted by this article with questionable results
Didnt anyone check whether this article can be relied upon? What would be the spread of information via so many twitter and facebook feeds and blogs?
On top of it, 67 citations for this research article? Didnt other researchers or authors start getting the same questions that crop up here? How could they blindly follow this research article?
5. Resuming again from Comment 3., article "Viral dynamics in mild and severe cases of COVID-19" also depends on the above article discussed in comment 4., and authors are banking heavily on the above article by citing it in the third sentence of their manuscript. When the merit of the cited article raises so many questions as in comment 4., how could the authors bank on the above article? When the merit of the base article becomes questionable, wont the merit of this article (that banks on the base article) also become questionable?
6. Quote "Findings from Feb, 2020, indicated that the clinical spectrum of this disease can be very heterogeneous." End of Quote. Article analysed in Comment 4 is indicated as reference for this statement. When the original article itself has restricted data upto Jan 31, 2020, how can this article indicate Findings from Feb, 2020, when this banks on the original article whose data is only upto Jan 31, 2020? Does this indicate carelessness by the authors? Further, another question arises, that when the foundation itself is shaky, how can another article ride piggy back on it, especially by citing it erroneously too? Suspected propagation of error and amplication of error from foundation article to this article?
7. Quote "Here, we report the viral RNA shedding patterns observed in patients with mild and severe COVID-19". This is the 4th sentence in the article. So far the authors have not defined or cited definition of mild and severe with reference to COVID-19. Should mild and severe be read as mild and severe for all conventional diseases or should mild and severe be read on a different scale with relevance to COVID-19? Authors are suggested to first introduce/explain various parameters that they would be using in the manuscript prior to using them? Else, the reader might get accustomed to the defines mild and severe and accept everything that follows without any scientific inquiry. Suspected Author bias.
8. Quote "76 patients admitted to the First Affiliated Hospital of Nanchang University (Nanchang, China) from Jan 21 to Feb 4, 2020, were included in the study" End of Quote
Quote "Coronavirus disease 2019 (COVID-19) is a new pandemic disease." End of Quote.
As per the Authors statement, the COVID-19 is a new pandemic disease. For investigating a pandemic disease (as per the authors statement), would a sample population of 76 be sufficient? Wouldnt the sample population be considered as insufficient to be considered as representative of the whole? In such a case, wouldnt the findings be trivial?
9. Quote "Parameters did not differ significantly between the groups, except that patients in the severe group were significantly older than those in the mild group, as expected.4" End of Quote. The authors are referring to https://doi.org/10.1016/S2213-2600(20)30079-5 cited as Reference no. 4 and stating that Parameters across mild and severe groups were the same, except that patients in the severe group were older than those in the mild group, which was as expected as per Reference no. 4, which is https://doi.org/10.1016/S2213-2600(20)30079-5 published online on Feb 24, 2020.
9a. Preliminary examination of https://doi.org/10.1016/S2213-2600(20)30079-5 indicated the following interesting extract
Quote "In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020" End Quote
The sample population itself was only 52 and they were adult and critically ill.
Further, Quote "The mean age of the 52 patients was 59·7" End Quote
So, if a sample population was 52 adult patients with a mean age of 59.7, enrolled for study when they were already critically ill, then, however experimented, the finding is going to be only about adult patients who are critically ill, and the finding cannot reflect any younger age group who were not critically ill, coz the choice was adult patients who were critically ill. Stated in simple terms, the spoon can serve only what is already there in the vessel.
9b. Reading Comment 9 & 9a together, what do the authors mean that they investigated and found that older patients were in the severe group as expected, based on results on another study which studied only older patients. Isnt this absurd/ridiculous? Do the authors expect that the reader will be so careless to accept whatever is written? Author bias suspected.
9c. On top of it, reading together Comment 4d, so many people seem to have become so engrossed by this article, flooding social media and causing such widespread dissemination of such questionable research reporting?
10. Quote "Overall, our data indicate that, similar to SARS in 2002–03,6 patients with severe COVID-19 tend to have a high viral load and a long virus-shedding period. " End of Quote. Authors seem to be banking their results on Reference No. 6 https://doi.org/10.1503/cmaj.1040398
10a. Preliminary Examination of https://doi.org/10.1503/cmaj.1040398 indicates that
Quote "It is difficult to compare case-fatality ratios between different cohorts and countries. Differences in distribution in terms of age, sex, disease activity (reflected by lactate dehydrogenase level) and proportion of cases confirmed by virologic tests have been cited as possible reasons for differences in case-fatality ratios.12 Our results suggest that such variation should be interpreted in light of host factors (age and comorbidity) and viral factors (viral load). In future studies, viral load should be monitored and analyzed, so that it can be considered in the interpretation of outcome data." End Quote.
10b. The article that the authors are banking on as indicated in Comment 10a does not directly emphasize on high viral load and long virus-shedding period but rather indicates that variations can be there due to differences between cohorts (societal/community populations), countries, age, sex, disease activity. Further it emphazises that viral load should be monitored and analyzed, so that it can be considered in the interpretation of outcome data.
10c. Reading together Comments 10, 10a and 10b, the authors are trying to bank significance on high viral load and long virus-shedding period on another article which states that there can be differences due to various factors and viral load needs to be monitored and analysed. In such a case, what is the point that the authors are trying to make by attempting to add significance to concerns which might manifest differently? So, does it mean that patients with severe COVID-19 can have variability due to viral load and virus-shedding period? If there is variability, then what is the significance of the findings of this paper?
11. Quote "This finding suggests that the viral load of SARS-CoV-2 might be a useful marker for assessing disease severity and prognosis." End Quote.
Reading together Comment 10, 10a-c, when the finding itself has lost its significance, how can the viral load of SARS-CoV-2 might be a useful marker for assessing disease severity and prognosis?
12. Apart from insight obtained via Comment 10a, there doesnt seem any significant research information in this article. Or have the authors failed to defend their point? However, Comment 10a stands out, and that seems to show a brighter side. Perhaps, the key to handling COVID-19 lies in Comment 10a. Exploitation of significance of Comment 10a might show a way for the world to win the battle against the COVID-19.
13. In the midst of such storms caused by COVID-19, have we accidentally identified "A faint beam of light at the end of the tunnel.... " !!!
Part II. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "How will country-based mitigation measures influence the course of the COVID-19 epidemic?" Published: March 09, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30567-5
Publons Review Link:
Post Publication Independent Review of
How will country-based mitigation measures influence the course of the COVID-19 epidemic?
Roy M Anderson, Hans Heesterbeek, Don Klinkenberg, T Déirdre Hollingsworth
Published:March 09, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30567-5
1. The title gives an impression that this article might provide valuable insight regarding effectiveness or expected outcomes of country based mitigation measures with reference to COVID-19.
2. Quote "Governments will not be able to minimise both deaths from coronavirus disease 2019 (COVID-19) and the economic impact of viral spread" End of Quote. The first line of the manuscript states so. It gives rise to a doubt whether the manuscript is only one sentence long. In the title, the authors have asked a question. In the first line of the manuscript they have answered in the negative. Does it mean that the manuscript is only one sentence long?
2a. What was the need for the authors to make such an opening statement? Is it supported by any analysis? But no analysis is found, coz between the title and the first line, there is only some blank space. Blank space cannot be accepted as a defense/justification for making such a statement in a research article.
2b. Were the authors already Heads of many Governments that they are making such a statement from their experience as Heads of Government of various nations?
2c. Were the authors trying to heighten reader anxiety by exploiting the fact that fatality due to COVID-19 has been high?
2d. Authors need to realize that making such opening statements will not help provide any significant research outcome from their article, as this is a research manuscript and is not any brochure (to attempt to make an opening impression).
3. Quote "Keeping mortality as low as possible will be the highest priority for individuals" End of Quote. How can individuals try to keep mortality as low as possible with a high priority. Authors need to understand that as far as an individual is concerned, he is either going to be alive or dead. There are only two options, that is being either alive or dead and there is no possibility that the patient cannot be neither alive nor dead and also there is no possibility that the patient can be both alive and dead (applying Quantum Superposition). So, the only possibility is that the individual can be either alive or dead. When there are only two states, similar to on-off states, the above sentence "Keeping mortality as low as possible will be the highest priority for individuals" has no meaning.
4. Quote "Keeping mortality as low as possible will be the highest priority for individuals; hence governments must put in place measures to ameliorate the inevitable economic downturn" End of Quote. What is the relation between an individual trying to stay alive and govt. reaction to economic downturn? Maybe it can be explained with a simile. If it is said that the Devil and the Deep Sea are related to each other, atleast they have two alphabets similar "De". How are the authors trying to relate the action of an individual trying to stay alive and govt. reaction to encomic downturn? Especially with no defense or justification?
5. Quote "In our view, COVID-19 has developed into a pandemic, with small chains of transmission in many countries and large chains resulting in extensive spread in a few countries, such as Italy, Iran, South Korea, and Japan.1 " End of Quote.
This sentence cites the following article (listed as Reference 1)
Coronavirus disease 2019 (COVID-19) situation report—44.
Date: March 4, 2020
(accessed March 5, 2020).
Preliminary examination of the cited WHO article indicates that it is an official document of the WHO and authors list doesnt seem to be provided, which implies that the authors of this article may not have been authors of the WHO document. So, how can the authors state that "In our view" and cite a WHO article, when there doesnt seem any evidence that they have authored the WHO document?
Then, the WHO document is published on March 4, 2020; accessed by the authors on March 5, 2020 and this research article is published on March 09, 2020.
Even if the authors wrote this research article on the same day, that is March 5, 2020 and submitted on the same day, how was the article published on March 09, 2020 in a matter of just a few days? Was this article able to be processed, evaluated and processed in such a short time?
If the authors were not able to complete the article on the same day that is March 5, 2020, then they could have submitted it later, in which case, the processing time for the article becomes still more reduced. How were the authors able to get this research article, involving a very serious current health concern of the world, processed and published in a matter of just a few days or hours?
Further, why are the authors focussing attention on Italy, Iran, South Korea and Japan?
Examination of the WHO document
Table 2. Countries, territories or areas outside China with reported laboratory-confirmed COVID-19 cases and
deaths. Data as of 04 March 2020
classified as Western Pacific Region, European Region, South-East Asia Region, Eastern Mediterranean Region, Region of the Americas, African Region.
The countries mentioned by the authors, namely Italy, Iran, South Korea, and Japan appear as follows.
European Region S. No. 1. Italy 2502
Eastern Mediterranean Region S. No. 1. Iran (Islamic Republic of) 2336
Western Pacific Region S. No. 1. Republic of Korea 5328 S. No. 2. Japan 284
Either the authors should have chosen the first serial number in each classification and indicated, but they have not done so.
If they have chosen the first and second serial numbers in each classification, then choice of the first and second items in Western Pacific Region might stand justified, but again they have not done so.
What was the rationale in choosing a random set of 4 nations with specific concentration to the Western Pacific Region?
On top of it, the authors never provided a defense or justification regarding how they could use the phrase "In our view" when there is no mention of it became their view.
6. Quote "Most countries are likely to have spread of COVID-19, at least in the early stages, before any mitigation measures have an impact." End of Quote. This sentence can also be written more precisely as "During the infinitesimal small duration between initiation and impact of mitigation measures, there can be a minimal spread of COVID-19", because what the authors have written boils down only to this statement. However the manner that the authors have written is that most countries are going to get affected before mitigation effects have an impact, and used the beauty of the language to disguise it. Now, why should the authors try to heighten reader anxiety by scaring them? Or were the authors trying to scare governments of various nations by their seemingly innocent statement? Author bias suspected.
7. Quote "What has happened in China shows that quarantine, social distancing, and isolation of infected populations can contain the epidemic.1 " End of Quote.
7a. Citing a WHO document, authors are very magnanimous in their praise for China. Is this a research article or are the authors trying to gain any undue advantage from China by singing its praise?
7b. Reading together Comment 6 and 7, according to the authors, the mitigation model of China alone can contain the epidemic compared to most other Nations. This article has been published on March 09, 2020.
Attention is drawn to https://www.worldometers.info/coronavirus/country/china/
As on March 09, 2020, total number of cases is 80,754. Number of active cases is 17,721. Number of deaths is 3,136. Number of new recoveries is 1,297. Number of new cases 19.
As on March 25, 2020, total number of cases is 81,285. Number of active cases is 3,947. Number of deaths is 3,287. Number of new recoveries is 401. Number of new cases 67.
If according to the authors, if the epidemic has been contained (for instance, taking the publication date of this research article as a reference), the figures are promising and are showing a good trend, but the disturbing factor is that beyond March 09, 2020, the number of new recoveries (which should have been showing an upward trend) displays a downward trend. It is supplemented by the number of new cases (which should be showing a downward trend) displays an upward trend.
When the statistics is examined, neither on the publication date of this research article were the trends very good nor did the trend start improving (post publication of this article) even if an futuristic allowance is permitted.
8. Reading Comment 6 and 7 together, it can be seen that China had its difficulties in mitigation measures and other Nations too could have possibly had difficulties in mitigation measures. But it is a disturbing sign that the authors have chosen to ignore facts but have tried to lavish their praise on China but at the same time discounting most other nations. Suspected absence of ethics in authors research statements.
9. Attention is drawn to News Item https://www.dailymail.co.uk/news/article-8155405/Up-14-cent-recovered-coronavirus-patients-China-test-positive-doctors-reveal.html PUBLISHED: 13:08 GMT, 26 March 2020 | UPDATED: 15:32 GMT, 26 March 2020
Highlights from news item:
Start of Highlights:
Three to 14 per cent of the patients tested positive after recovery, it is reported
Experts wondered if nucleic acid tests were reliable to detect traces of the virus
Medics said it was crucial to closely monitor those who were given the all-clear
China had discharged over 90 per cent of the infected as of Wednesday
Up to 14 per cent of the recovered coronavirus patients in China have tested positive again, medical experts have revealed.
Research showed about three to 14 per cent of the former patients were diagnosed with the virus once more after being given the all-clear.
The news came as experts feared that China is facing a second outbreak due to the increasing number of imported cases as well as the 'silent carriers' who show no symptoms.
End of Highlights:
Reading together with Comments 6, 7 & 8, a latest news item (while this Post Publication Review was being written),seems to indicate that China is facing difficulties even after clearing off people with complexities due to a second outbreak and silent carriers.
Reading together with Comments 5, 6, 7 & 8, what was the necessity for the authors to prepare submit a paper and get it published in a very short period of a few days or hours, singing praise of China and discounting other Nations, especially when other Nations had not felt the heat of COVID-19 outbreak (as on publication date of this paper)?
Manuscript seems to fail on ethics.
10. Quote "This impact of the COVID-19 response in China is encouraging for the many countries where COVID-19 is beginning to spread. However, it is unclear whether other countries can implement the stringent measures China eventually adopted" End of Quote. Authors sing more praise for China, perhaps never expected that reality might go against their research statements. Is this a research paper or have the authors tried to do a propaganda machine in support of China?
11. Quote "Singapore and Hong Kong, both of which had severe acute respiratory syndrome (SARS) epidemics in 2002–03, provide hope and many lessons to other countries. In both places, COVID-19 has been managed well to date, despite early cases, by early government action and through social distancing measures taken by individuals." Here the authors are singing praise of Singapore and Hong Kong. But above review comments do not permit attaching any scientific merit to these statements by the authors.
12. Quote "This is a very worst-case scenario for a number of reasons. We are uncertain about transmission in children, some communities are remote and unlikely to be exposed, voluntary social distancing by individuals and communities will have an impact, and mitigation efforts, such as the measures put in place in China, greatly reduce transmission." End of Quote. It is rather amusing to note that whatever the authors attempt to state, they eventually end up singing praise of China.
13. The authors are next discussing disease parameters. However, all those research discussions seem to lose their merit with relevance to News Item https://www.dailymail.co.uk/news/article-8155405/Up-14-cent-recovered-coronavirus-patients-China-test-positive-doctors-reveal.html PUBLISHED: 13:08 GMT, 26 March 2020 | UPDATED: 15:32 GMT, 26 March 2020. Hence discussions on disease parameters is unable to be accepted.
14. Quote "No vaccine or effective antiviral drug is likely to be available soon. Vaccine development is underway, but the key issues are not if a vaccine can be developed but where phase 3 trials will be done and who will manufacture vaccine at scale" End of Quote. Unwarranted statement by the authors. They cannot discount medical processes without any scientific reasoning and asking silly questions as "but the key issues are not if a vaccine can be developed but where phase 3 trials will be done and who will manufacture vaccine at scale". Authors scientific reasoning seems questionable and without merit.
15. Quote "The number of cases of COVID-19 are falling quickly in China,4 but a site for phase 3 vaccine trials needs to be in a location where there is ongoing transmission of the disease. Manufacturing at scale requires one or more of the big vaccine manufacturers to take up the challenge and work closely with the biotechnology companies who are developing vaccine candidates. This process will take time and we are probably a least 1 year to 18 months away from substantial vaccine production." The authors are discussing about vaccines, but again try to bring in a praise for China, without even realizing absurdity. What if the number of cases of COVID-19 are falling in China? Is there any rule that a site for phase 3 vaccine trials has to be setup/established only in China? Why cant a ite for phase 3 vaccine trials be set up in another Nation where there is ongoing transmission of disease at that time?
16. Quote "School closure, a major pillar of the response to pandemic influenza A,14 is unlikely to be effective given the apparent low rate of infection among children, although data are scarce." End of Quote. Authors shouldnt have made this statement when they already knew that data is scarce. Even if data is scarce, how can the authors state that school closure is unlikely to be effective? Dont the authors realize that when children go to school, so many processes and people and parents of children, teachers and others get involved so that the school processes are functional? Do the authors think that only children are involved in the school processes? Do the authors think that the children go to school, open the school, study, learn, teach, manage and also administer the school, and the processes, inclusive of financial processes? Children are only a part of the school processes as learners, and there are many others who are part of the school system. How can the authors make such irresponsible statements?
17. Quote "Avoiding large gatherings of people will reduce the number of super-spreading events; however, if prolonged contact is required for transmission, this measure might only reduce a small proportion of transmissions." End of Quote. If prolonged contact is required for transmission, what the authors state might be correct. But when the authors themselves are unable to state whether prolonged contact is required for transmission or only a infinitesimally small contact duration is sufficient for transmission, why should the authors discount the method of avoiding large gatherings of people?
18. Quote "Therefore, broader-scale social distancing is likely to be needed, as was put in place in China. This measure prevents transmission from symptomatic and non-symptomatic cases, hence flattening the epidemic and pushing the peak further into the future. " End of Quote. Again the authors have found an opportunity to sing praise of China. But at the same time, News Item https://www.dailymail.co.uk/news/article-8155405/Up-14-cent-recovered-coronavirus-patients-China-test-positive-doctors-reveal.html PUBLISHED: 13:08 GMT, 26 March 2020 | UPDATED: 15:32 GMT, 26 March 2020, seems to indicate otherwise. Authors should not have been in a hurry.
19. Figure with title "Illustrative simulations of a transmission model of COVID-19" seems to provide some infomation but is seen to carry a disclaimer that "Timing and width of peak uncertain due to Stochasticity in early dynamics, Heterogeneities in contact patterns, Spatial variation and Uncertainty in key epidemiological parameters". When such a disclaimer is provided for a transmission model of a disease, then the entire model cannot be relied upon.
20. Quote "Personal, rather than government action, in western democracies might be the most important issue. " End of Quote.
In the first line of this manuscript, authors state as below:
Quote "Governments will not be able to minimise both deaths from coronavirus disease 2019 (COVID-19) and the economic impact of viral spread" End of Quote.
Initially the authors discount the Governments of various nations. Then they shift the concerns to the individuals, clearing the Govt. off. Why are the authors incoherent?
21. Quote "There are difficult decisions ahead for governments. How individuals respond to advice on how best to prevent transmission will be as important as government actions, if not more important. Government communication strategies to keep the public informed of how best to avoid infection are vital, as is extra support to manage the economic downturn." End of Quote. This statement has just lost its significance with relevance to the National Lockdown enforced by India along with other support measures. This is the concluding statement of this manuscript and it has lost its significance too. Other insufficiencies observed have been discussed in Comments above.
22. Major observations about the manuscript is the seemingly harmless title, accompanied with discounting Governments of other Nations (right from the first line of the manuscript), while at the same time, praising China at every opportunity, with questionable insufficiencies related to author bias, ethics, and scientific merit.
Part III. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of COVID-19: what is next for public health? Published: February 13, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30374-3
Part III. A faint beam of light at the end of the tunnel....
Post Publication Independent Review of
COVID-19: what is next for public health?
David L Heymann
on behalf of the WHO Scientific and Technical Advisory Group for Infectious Hazards†
Published: February 13, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30374-3
Publons Review Link:
1. Quote "The WHO Scientific and Technical Advisory Group for Infectious Hazards (STAG-IH), working with the WHO secretariat, reviewed available information about the outbreaks of 2019 novel coronavirus disease (COVID-19) on Feb 7, 2020, in Geneva, Switzerland, and concluded that the continuing strategy of containment for elimination should continue, and that the coming 2–3 weeks through to the end of February, 2020, will be crucial to monitor the situation of community transmission to update WHO public health recommendations if required." End of Quote. The authors have been quite reasonable to take time to update public health recommendations, so that more observation data will be at hand and better insight can be obtained through analysis of the same.
2. Quote "Genetic analysis early in the outbreak of COVID-19 in China revealed that the virus was similar to, but distinct from, severe acute respiratory syndrome coronavirus (SARS-CoV), but the closest genetic similarity was found in a coronavirus that had been isolated from bats.1" End of Quote. The authors have made an important statement here, that the virus was similar to, but distinct from SARS-CoV.
This paper was published on February 13, 2020 and maybe this article was not given the much needed attention, as another article "Viral dynamics in mild and severe cases of COVID-19" Yang Liu, Li-Meng Yan, Lagen Wan, Tian-Xin Xiang, Aiping Le, Jia-Ming Liu et al. Published:March 19, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30232-2 (whose post publication review is available at https://www.prabhubritto.org/post-publication-independent-reviews-covid-19 ) is comparing with SARS data as follows:
Quote "Overall, our data indicate that, similar to SARS in 2002–03,6 patients with severe COVID-19 tend to have a high viral load and a long virus-shedding period. " End of Quote. Ofcourse, there was another difficulty with this statement of those authors, which is available as Review Comment 10 in Part I. A faint beam of light at the end of the tunnel.... at https://www.prabhubritto.org/post-publication-independent-reviews-covid-19
Reverting back to the discussion herewith, the authors of this article have made an important statement that the virus was similar to, but distinct from SARS, but the research community does not seem to have understood the significance of this statement and published their research articles based on erroneous understanding, without giving due significance to the point mentioned in this research article.
3. Quote "As there was in early January, 2020, scarce information available about the outbreak, knowledge from outbreaks caused by the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV) formed the basis for WHO public health recommendations in mid-January.2 " End of Quote. Acceptable.
4. Quote "However, the availability of more evidence in the past month has shown major differences between the outbreaks and characteristics of COVID-19 compared with those of SARS-CoV." End of Quote. This statement is quite significant as the protocols, procedures and handling is going to be unique. This indicates that the outbreak of COVID-19 cannot be handled as other outbreaks were handled earlier. This makes essential the cooperation at Levels of Governments & Nations to formulate unique contingency plans to contain and treat the outbreak.
5. Quote "Recognising the Wuhan-focused and nationwide outbreak responses in China, WHO has encouraged countries with heavy air travel exchange with Wuhan to take precautionary public health measures2 and, if there is imported infection, to undertake activities that could lead to the elimination of the virus in human populations as occurred during the 2003 SARS outbreak.3 " End of Quote. This indicates that the primary channels of communication of the disease into each Nation are going to be those populations that come into proximity with travellers from Wuhan in specific and China in general. Identification & Quarantine of people with travel history relating to Wuhan & China will have to be done, so that the outbreak can be contained better.
6. Quote "COVID-19 is thought to have been introduced to human populations from the animal kingdom in November or December, 2019, as suggested by the phylogeny of genomic sequences obtained from early cases.7 The genetic epidemiology suggests that from the beginning of December, 2019, when the first cases were retrospectively traced in Wuhan, the spread of infection has been almost entirely driven by human-to-human transmission, not the result of continued spillover. There was massive transmission in a matter of weeks in Wuhan, and people in the resulting chains of transmission spread infection by national and international travel during the Chinese New Year holidays." End of Quote. This statement is quite significant with relevance to the expected outcome that through the international travellers, the whole world would get infected; and the effect will be felt on a very large footprint of the people, as a diverse cross section of the society comes into contact with an international traveller at multiple points.
7. Quote "COVID-19 seems to have different epidemiological characteristics from SARS-CoV. COVID-19 replicates efficiently in the upper respiratory tract and appears to cause less abrupt onset of symptoms, similar to conventional human coronaviruses that are a major cause of common colds in the winter season.8 Infected individuals produce a large quantity of virus in the upper respiratory tract during a prodrome period, are mobile, and carry on usual activities, contributing to the spread of infection. " End of Quote. This statement indicates that a client carrying the virus, would have maximally spread the virus, during the time that the client is active in the prodrome period. After the client is diagnosed positive, it will be a very difficult task to perform contact tracing to search and identify other prospective human beings who have come in contact and took a portion of the virus with them; the difficulty being that it is not going to be a linear path but branching out as a new path at every intersection or meeting point with another human being; in short it will be a web that spreads out radially and rapidly; within no time, engulfing the entire population and the population also will not be aware that they have contacted the virus as they will also be active during their prodrome period. This statement by the authors should have been given or should be given due respect to prevent the spread of the outbreak.
8. Quote "By contrast, transmission of SARS-CoV did not readily occur during the prodromal period when those infected were mildly ill, and most transmission is thought to have occurred when infected individuals presented with severe illness, thus possibly making it easier to contain the outbreaks SARS-CoV caused, unlike the current outbreaks with COVID-19.6" End of Quote. This statement needs to be read together with Review Comment 7.
9. Quote "COVID-19 also has affinity for cells in the lower respiratory tract and can replicate there, causing radiological evidence of lower respiratory tract lesions in patients who do not present with clinical pneumonia.8 There seem to be three major patterns of the clinical course of infection: mild illness with upper respiratory tract presenting symptoms; non-life-threatening pneumonia; and severe pneumonia with acute respiratory distress syndrome (ARDS) that begins with mild symptoms for 7–8 days and then progresses to rapid deterioration and ARDS requiring advanced life support" End Quote. This statement indicates that there is going to be a surprise after a short period. Treatment protocols are usually based on symptoms. When the symptoms are non-life threatening, the treatment protocol will not call for emergency procedures. But, immediately after a few days, symptoms turn from mild to critical, calling for emergency treatment protocols. This is where the difficulty actually lies. All patients with mild symptoms cannot be put on emergency protocols even when they dont display life-threatening symptoms; expecting that all will test positive for COVID-19 in a few days. Rapid deterioration of an otherwise healthy population into one with life-threatening symptoms will place an unbearable load on the treatment facilities and clinical personnel; coz make-shift Intensive Care Units cannot be commissioned at will, with ventilator facility for each bed (as the manifestation of the disease is going to be more prevalently felt in the respiratory function).
10. Quote "The case fatality ratio with COVID-19 has been difficult to estimate. The initial case definition in China included pneumonia but was recently adjusted to include people with milder clinical presentation and the current estimate is thought to be about 1–2%, which is lower than that for SARS (10%).9 The actual case fatality ratio of infection with COVID-19 will eventually be based on all clinical illness and at the time of writing information on subclinical infection is not available and awaits the development of serological tests and serosurveys." End of Quote. If what the authors have written is true, then the fatality rate of COVID-19 is going to be very much higher than actuals; coz the actual fatality rate can be decided only after including subclinical infection; that means that many deaths recorded under various reasons might have actually been caused by COVID-19.
11. Quote "Presently COVID-19 seems to spread from person to person by the same mechanism as other common cold or influenza viruses—ie, face to face contact with a sneeze or cough, or from contact with secretions of people who are infected. The role of faecal–oral transmission is yet to be determined in COVID-19 but was found to occur during the SARS outbreak.10" End of Quote. Reference 10 cited here gives indepth insight into the spread of SARS https://jech.bmj.com/content/jech/57/9/652.full.pdf If COVID-19 can spread as SARS spread, then the entire sewage connectivity itself will blow the disease into most people. Though the role of faecal-oral transmission is yet to be determined in COVID-19, it doesnt rule out that COVID may not spread like or spread more worse than SARS via faecal-oral transmission through sewage pathways.
12. Quote "A plausible scenario based on the available evidence now is that the newly identified COVID-19 is causing, like seasonal influenza, mild and self-limiting disease in most people who are infected, with severe disease more likely among older people or those with comorbidities, such as diabetes, pulmonary disease, and other chronic conditions." End of Quote. This statement indicates that people with existing comorbidities are at more risk of infection from COVID-19 compared to healthy individuals.
13. Quote " Health workers and carers are at high risk of infection, and health-care-associated amplification of transmission is of concern as is always the case for emerging infections. People in long-term care facilities are also at risk of severe health consequences if they become infected." End of Quote. This statement needs to be given attention, because it indicates the potential for collateral damage.
14. Quote "Non-pharmaceutical interventions remain central for management of COVID-19 because there are no licensed vaccines or coronavirus antivirals. If the situation changes towards much wider community transmission with multiple international foci, the WHO strategy of containment for elimination could need to be adjusted to include mitigation strategies combined with the following activities currently recommended by STAG-IH on the WHO website." End of Quote. The need for strategic containment of the spread of the outbreak is spelt out here. Either a risky restricted community interaction can be maintained or a less risky total lockdown may be explored. If people can be made to co-operate, the less risky total lockdown may be a better solution.
15. Quote "First, close monitoring is needed of changes in epidemiology and of the effectiveness of public health strategies and their social acceptance." End of Quote. Since all existing functionaries of the Govt. will have their own roles to play in such nationwide outbreaks, a special team can be conveyed to implement this suggestion.
16. Quote "Second, continued evolution is needed of enhanced communication strategies that provide general populations and vulnerable populations most at risk with actionable information for self-protection, including identification of symptoms, and clear guidance for treatment seeking." End of Quote. Again, a new dedicated team needs to conveyed to fulfil this suggestion.
17. Quote "Third, continued intensive source control is needed in the epicentre in China—ie, isolation of patients and persons testing positive for COVID-19, contact tracing and health monitoring, strict health facility infection prevention and control, and use of other active public health control interventions with continued active surveillance and containment activities at all other sites where outbreaks are occurring in China.
Fourth, continued containment activities are needed around sites outside China where there are infected people and transmission among contacts, with intensive study to provide information on transmissibility, means of transmission, and natural history of infection, with regular reporting to WHO and sharing of data.
Fifth, intensified active surveillance is needed for possible infections in all countries using the WHO-recommended surveillance case definition.11" End of Quote. Hereagain, it could be any Nation instead of China, and dedicated new teams may be convened for each of these suggestions.
18. Quote "Sixth, preparation for resilience of health systems in all countries is needed, as is done at the time of seasonal influenza, anticipating severe infections and course of disease in older people and other populations identified to be at risk of severe disease." End of Quote. May be handled at the level of the Ministry of Health.
19. Quote "Seventh, if widespread community transmission is established, there should then be consideration of a transition to include mitigation activities, especially if contact tracing becomes ineffective or overwhelming and an inefficient use of resources. Examples of mitigation activities include cancelling public gatherings, school closure, remote working, home isolation, observation of the health of symptomatic individuals supported by telephone or online health consultation, and provision of essential life support such as oxygen supplies, mechanical ventilators and extracorporeal membrane oxygenation (ECMO) equipment." End of Quote. India seems to be doing this (at the time of writing down this review).
20. Quote "Eighth, serological tests need to be developed that can estimate current and previous infections in general populations." End of Quote. May be handled at the level of the Ministry of Health, nationwide.
21. Quote "Finally, continued research is important to understand the source of the outbreak by study of animals and animal handlers in markets to provide evidence necessary for prevention of future coronavirus outbreaks." End of Quote. This suggestion can be extended as all-inclusive and a dedicated vertical structure can be built in National Interests.
Part IV. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of COVID-19 and Italy: what next? Published: March 13, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30627-9
Publons Review Link:
Post Publication Independent Review of
COVID-19 and Italy: what next?
Prof Andrea Remuzzi, EngD
Prof Giuseppe Remuzzi, MD
Published: March 13, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30627-9
1. Quote "A global response to prepare health systems worldwide is imperative. Although containment measures in China have reduced new cases by more than 90%, this reduction is not the case elsewhere, and Italy has been particularly affected. There is now grave concern regarding the Italian national health system's capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia." End of Quote. The authors seem to make an attempt to bring out new research insights which might be helpful for Italy and for all Nations due to the well accepted treatise that "Italy’s healthcare system is routinely ranked among the best in the world, based on its overall quality, equity of access, and the general health and life expectancy of the Italian population" https://www.italymagazine.com/featured-story/healthcare-italy-what-you-need-know
2. Quote "Our analysis might help political leaders and health authorities to allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. " End of Quote. Authors statement is sufficient. Doesnt need a further comment.
3. Quote "If the Italian outbreak follows a similar trend as in Hubei province, China, the number of newly infected patients could start to decrease within 3–4 days, departing from the exponential trend. However, this cannot currently be predicted because of differences between social distancing measures and the capacity to quickly build dedicated facilities in China." End of Quote. The authors are more pragmatic in their approach and not quick to jump in with supporting decisions only coz a unique trend was observed.
Further, read together with https://www.moneycontrol.com/news/india/coronavirus-pandemic-johns-hopkins-university-distances-self-from-report-claiming-40-crore-indians-may-get-coronavirus-by-july-5079281.html , it can be understood why a more pragmatic approach is required in research analysis and inferences, else research inferences may spin out of practicality into utopia and can even create an environment of psychosis in the society. Hence, as the authors of this research article have done, research inferences have to be more pragmatic in their approach.
4. Quote "Therefore, a coordinated global response is desperately needed to prepare health systems to meet this unprecedented challenge." End Quote. A multi-national tactical command and control center may be established in any Nation that is willing to offer this service to the World. Distributed Centers may be established in the Capital of ever Nation, connecting upto grassroots level.
5. Quote "Countries that have been unfortunate enough to have been exposed to this disease already have, paradoxically, very valuable lessons to pass on." End of Quote. The authors are right on this point. It is time to learn valuable lessons for the sake of our Nations and pass on the significant insights to other Nations
6. Quote "Although the containment measures implemented in China have—at least for the moment—reduced new cases by more than 90%, this reduction is not the case in other countries, including Italy and Iran.2" End of Quote.
The authors have cited https://www.economist.com/graphic-detail/2020/03/07/tourism-flows-and-death-rates-suggest-covid-19-is-being-under-reported as Reference number 2. The cited article gives more valuable insight as following:
As covid-19 reaches countries unwilling or unable to monitor it, officials must use educated guesswork to track its evolution.
The number of cases each country reports depends both on the number of infections and on how many people get tested.
To derive fresh estimates, The Economist built a similar model. We tested the link within the oecd—a club of mostly rich countries, which should have strong detection capacity—between Chinese tourism in 2019 and confirmed covid-19 cases. As expected, oecd states that swapped lots of tourists with China, such as Switzerland, tend to report higher infection rates than do ones with small flows, like Belgium.
Applied worldwide, our model finds big outliers. The outbreaks in Iran, Italy and South Korea, where the virus is spreading internally, are bigger than tourist flows suggest. At the other extreme, countries like Singapore may have fewer diagnoses than expected because of strong containment efforts. But the Philippines, Russia, Myanmar and Indonesia have lots of people and tourism to and from China, and just eight confirmed cases in total. Thousands more have probably gone undetected.
Another pattern bolsters this finding. South Korea and China test regularly. In both places—excluding Hubei, where the virus began claiming lives before authorities formulated a response—0.5-1% of people who have tested positive have died. In other countries with at least one death, this rate is five times higher. Deaths are easier to count than infections are. The most likely explanation for this gap is that for every person diagnosed in these countries, four more do not know they are infected
" End of Quote.
These insights are crucial for Nations to prepare, evolve and continuously modify their COVID-19 National-Level containment and treatment protocols.
7. Quote "The mean age of those who died in Italy was 81 years and more than two-thirds of these patients had diabetes, cardiovascular diseases, or cancer, or were former smokers. It is therefore true that these patients had underlying health conditions, but it is also worth noting that they had acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, needed respiratory support, and would not have died otherwise. " End of Quote.
The Healthcare system in Italy is known to be one of the best in the world. Consequently, the mean age of those who died in Italy may have been 81 years, but we cannot derive any direct inference from it, for the simple reason that it is going to vary among ethnicities, populations and nations; also dependent on the quality of healthcare in that Nation.
Further, it can be seen that comorbities make things more difficult for a COVID-19 patient. The COVID-19 patient may progress into Acute Respiratory Distress Syndrome (ARDS), but when comorbities are present, it paints a more critical picture. This means that containment & treatment strategies for otherwise normal population and those with pre-existing comorbities may be unique and distinct and may need to be given more attention while devising plans & during adaptive implementation.
8. Quote "On March 8, 2020, the Italian Government implemented extraordinary measures to limit viral transmission—including restricting movement in the region of Lombardy—that intended to minimise the likelihood that people who are not infected come into contact with people who are infected. This decision is certainly courageous and important, but it is not enough. At present, our national health system's capacity to effectively respond to the needs of those who are already infected and require admission to an intensive care unit for ARDS, largely due to SARS-CoV-2 pneumonia, is a matter of grave concern." End of Quote.
Quote "In Italy, we have approximately 5200 beds in intensive care units. Of those, as of March 11, 1028 are already devoted to patients with SARS-CoV-2 infection, and in the near future this number will progressively increase to the point that thousands of beds will soon be occupied by patients with COVID-19. Given that the mortality of patients who are critically ill with SARS-CoV-2 pneumonia is high and that the survival time of non-survivors is 1–2 weeks, the number of people infected in Italy will probably impose a major strain on critical care facilities in our hospitals, some of which do not have adequate resources or staff to deal with this emergency."
This observation by the authors may raise alarm bells throughout all Nations, as patients with COVID-19 may have to be admitted into ICU, and with a survival time of non-survivors being 1-2 weeks, bed occupancy is going to be a major factor. The Nations will have to find new ways and means to improvise more ICU units into hospitals or new standalone ICU units.
At the time of writing this review, India is seen taking concrete steps in this direction, as evidenced by the following links.
9. Quote "We present the following predictions to prepare our political leaders—those who bear the greatest responsibility for national health systems and the government at the regional level, as well as local health authorities—for what is predicted to happen in the days and weeks to come. They can then implement measures regarding staff resources and hospital beds to meet the challenges of this difficult time. " End of Quote.
The authors are appreciated for this measure, wherein they have exhibited their foresight.
10. Some enlightening observations by the authors is summarised below.
Quote "On the basis of the exponential curve prediction, and the assumption that the duration of infection ranges from 15 to 20 days, it is possible to calculate that the basic reproduction number ranges from 2·76 to 3·25. This number is similar to that reported for the initial phase of the infection outbreak in the city of Wuhan, China3 and slightly higher than 2·2, as reported by Li and colleagues in a more recent report.4" End of Quote.
Quote "The number of patients admitted to intensive care units increased similarly in Italy, with an exponential trend up until March 8. " End of Quote.
Quote "The data available up until March 8 show that the trend in the number of patients who will need admission to intensive care units will increase substantially and relentlessly in the next few days. We can predict with quite a good degree of accuracy that this number will push the national health system to full capacity in a matter of days. " End of Quote.
Quote "At this point, the most important question is whether the increase in the number of patients who are infected and those requiring intensive care admittance will continue to rise exponentially and for how long. If the change in the slope of the curve does not take place soon, the clinical and social problems will take on unmanageable dimensions, which are expected to have catastrophic results. " End of Quote.
Quote " If the Italian outbreak follows a similar trend to that in China, we can suggest that the number of newly infected patients might start to decrease within 3–4 days from March 11. Similarly, we can foresee that the cumulative curve of patients who are infected will peak 30 days later, with the maximum load for clinical facilities for the treatment of these patients foreseen for that period." End of Quote.
In Summary, we can understand that initially there may be a high proportion of new infections which will start reducing over a given period, but the cumulative number of patients will be steadily increasing, and if the infection is assumed to range between 15 to 20 days, the cumulative demand on ICU beds with respiratory support is going to exponentially shoot over a period of time.
While this review is being written, India is taking drastic steps to boost its capacity for tougher challenges ahead.
11. Quote "Finally, our analysis tends to suggest that measures to reduce transmission should certainly be implemented, as our government did on March 9, by inhibiting people's movement and social activities, unless strictly required. Rather than revising the Schengen visa-free zone, the most effective way to contain this viral outbreak in European countries is probably to avoid close contact at the individual level and social meetings in each country." End of Quote.
At the time of writing this review, India is currently under a nationwide 21 day lockdown, severely restricting human movement (unless essential). To prevent transit of migrant labourers (who might be rendred jobless during this 21 day National lockdown), the Union Home Ministry has empowered the various States in India to use the State Disaster Relief Fund for relief measures for migrant laborers (rendered jobless) during this 21 day National lockdown.
Part V. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Online mental health services in China during the COVID-19 outbreak" Published: February 18, 2020 DOI: https://doi.org/10.1016/S2215-0366(20)30077-8
Publons Review Link:
Post Publication Independent Review of
Online mental health services in China during the COVID-19 outbreak
Shuai Liu, Lulu Yang, Chenxi Zhang, Yu-Tao Xiang, Zhongchun Liu, Shaohua Hu et al.
Published: February 18, 2020 DOI: https://doi.org/10.1016/S2215-0366(20)30077-8
1. Quote "Since January, 2020, the National Health Commission of China have published several guideline documents, starting with the notification of principles for emergency psychological crisis intervention for the COVID-19 epidemic on January 26, then the notice on establishing psychological assistance hotlines for the epidemic on February 2, and most recently, guidelines for psychological assistance hotlines during the COVID-19 epidemic on February 7.3" End of Quote. This article points to an additional load on the National Health System in areas related to psychiatry.
2. Quote " The popularisation of internet services and smartphones, and the emergence of fifth generation (5G) mobile networks, have enabled mental health professionals and health authorities to provide online mental health services during the COVID-19 outbreak." End of Quote. Capability to provide solutions exist and is not a burden to create as a new health infrastructure.
3. Quote "One such multicentre survey involving 1563 medical staff, with our centre at Nanfang Hospital, Southern Medical University (Guangzhou, China) as one of the study sites, found the prevalence of depression (defined as a total score of ≥5 in the Patient Health Questionnaire-9) to be 50·7%, of anxiety (defined as a total score of ≥5 in the Generalized Anxiety Disorder-7) to be 44·7%, of insomnia to be 36·1% (defined as a total score of ≥8 in the Insomnia Severity Index), and of stress-related symptoms (defined as a total score of ≥9 in the Impact of Events Scale-Revised) to be 73·4%. These findings are important in enabling health authorities to allocate health resources and develop appropriate treatments for medical staff who have mental health problems." End of Quote. Every Nation may not have the same percentage distribution, but this can be taken as a ground truth model or as an evolutionary model. Surveys and Analysis may need to be done afresh, as variations might be manifested due to variations in demographies, ethnicities, populations, etc.
4. Quote "Secondly, online mental health education with communication programmes, such as WeChat, Weibo, and TikTok, has been widely used during the outbreak for medical staff and the public. In addition, several books on COVID-19 prevention, control, and mental health education have been swiftly published and free electronic copies have been provided for the public. " End of Quote. These options can be explored.
5. Quote "As of February 8, 29 books associated with COVID-19 have been published, 11 (37·9%) of which are on mental health, including the “Guidelines for public psychological self-help and counselling of 2019-nCoV pneumonia”, published by the Chinese Association for Mental Health" End of Quote. The Ministry or Department of Health/Health Research can take a call whether the same guidelines can be used generically or unique guidelines need to be issued for the Nation.
6. Quote "Finally, online psychological counselling services (eg, WeChat-based resources) have been widely established by mental health professionals in medical institutions, universities, and academic societies throughout all 31 provinces, municipalities, and autonomous regions in mainland China, which provide free 24-h services on all days of the week. Online psychological self-help intervention systems, including online cognitive behavioural therapy for depression, anxiety, and insomnia (eg, on WeChat), have also been developed. In addition, several artificial intelligence (AI) programmes have been put in use as interventions for psychological crises during the epidemic. For example, individuals at risk of suicide can be recognised by the AI programme Tree Holes Rescue,5 by monitoring and analysing messages posted on Weibo, and alerting designated volunteers to act accordingly." End of Quote. Seems to be good and feasible solutions. Can be implemented generically or with unique guidelines designed for the Nation.
7. Quote "online mental health services being used for the COVID-19 epidemic are facilitating the development of Chinese public emergency interventions, and eventually could improve the quality and effectiveness of emergency interventions." End of Quote. These may be solutions that can help to prepare for handling future health outbreaks, and also for handling unexpected contingencies that arise. For instance, the migrant labourers mass exodus to their native places from their place of work, caused inconvenience both to the migrant labourers and also to the health system which was enforcing a 21 day lockdown with reference to containing the spread of COVID-19, causing the Prime Minister of India to issue an apology as an immediate damage control measure to prevent it from spiralling out of control.
The absence of such counselling services fuelled the hundreds and thousands of migrant laborers to hit the roads on a massive scale, while the Central & State Govts were preparing to handle it, the issue exploded even before & while the Central Govt. could authorize & was authorizing the State Governments to use the Disaster Relief Fund to provide immediate relief.
Everytime, the Prime Minister cannot pitch in with an apology to save the situation, and such a precedence should not be set. The Office of the Prime Minister should always be let to maintain its dignified standing in the National and International Levels, and the Prime Minister should not be forced into a situation as issuing an apology, and such a precedence should not be set too. Consequently, such counselling services may need to be treated as an immediate priority and established nationwide, via radio, television and internet channels of communication, to prevent outbreak of unexpected outcomes during National/International Level Disasters/Emergencies/HealthCalamities.
Part VI. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of Mental health care for medical staff in China during the COVID-19 outbreak Published: February 18, 2020 DOI: https://doi.org/10.1016/S2215-0366(20)30078-X
Publons Review Link:
Post Publication Independent Review of
Mental health care for medical staff in China during the COVID-19 outbreak
Qiongni Chen, Mining Liang, Yamin Li, Jincai Guo, Dongxue Fei, Ling Wang et al.
Published: February 18, 2020 DOI: https://doi.org/10.1016/S2215-0366(20)30078-X
1. Quote "The Second Xiangya Hospital—workplace of the chairman of the Psychological Rescue Branch of the Chinese Medical Rescue Association—and the Institute of Mental Health, the Medical Psychology Research Center of the Second Xiangya Hospital, and the Chinese Medical and Psychological Disease Clinical Medicine Research Center responded rapidly to the psychological pressures on staff." End of Quote.
The Authors bring out an essential aspect of the entire COVID-19 containment and treatment protocols, viz., "Psychological Rescue" for Medical Staff (Doctors, Nurses, Allied Medical Staff, Volunteers, etc.) involved in COVID-19 containment and treatment protocols. The Medical Staff stand on the first line of service with the COVID-19 patients, screening populations, etc. If the Medical Staff get overwhelmed, the first line of service can start get deficiencies, which might even affect the entire COVID-19 containment and treatment protocols. Hence, it is essential that Medical Staff are provided Quality Psychological Rescue to cope up with the stress of the COVID-19 containment and treatment.
2. Quote "A detailed psychological intervention plan was developed, which mainly covered the following three areas: building a psychological intervention medical team, which provided online courses to guide medical staff to deal with common psychological problems; a psychological assistance hotline team, which provided guidance and supervision to solve psychological problems; and psychological interventions, which provided various group activities to release stress. " End of Quote.
The text speaks for itself.
3. Quote "However, the implementation of psychological intervention services encountered obstacles, as medical staff were reluctant to participate in the group or individual psychology interventions provided to them. Moreover, individual nurses showed excitability, irritability, unwillingness to rest, and signs of psychological distress, but refused any psychological help and stated that they did not have any problems." End of Quote. This would exhibit as strange behaviour, but the reasons that follow in the next paragraphs are thought provoking.
4. Quote "First, getting infected was not an immediate worry to staff—they did not worry about this once they began work. Second, they did not want their families to worry about them and were afraid of bringing the virus to their home. Third, staff did not know how to deal with patients when they were unwilling to be quarantined at the hospital or did not cooperate with medical measures because of panic or a lack of knowledge about the disease. Additionally, staff worried about the shortage of protective equipment and feelings of incapability when faced with critically ill patients. Many staff mentioned that they did not need a psychologist, but needed more rest without interruption and enough protective supplies. Finally, they suggested training on psychological skills to deal with patients' anxiety, panic, and other emotional problems and, if possible, for mental health staff to be on hand to directly help these patients." End of Quote.
The points raised by the Medical Staff are something that every Nation needs to attend to, right from the very beginning; as the Medical Staff play the pivotal role in containing and treating COVID-19. Only when the Medical Staff are empowered to handle the concerns, they will be able to serve well, and also help maintain themselves to continue the service that is most valuable.
5. Quote "Accordingly, the measures of psychological intervention were adjusted. First, the hospital provided a place for rest where staff could temporarily isolate themselves from their family. The hospital also guaranteed food and daily living supplies, and helped staff to video record their routines in the hospital to share with their families and alleviate family members' concerns. Second, in addition to disease knowledge and protective measures, pre-job training was arranged to address identification of and responses to psychological problems in patients with COVID-19, and hospital security staff were available to be sent to help deal with uncooperative patients. Third, the hospital developed detailed rules on the use and management of protective equipment to reduce worry. Fourth, leisure activities and training on how to relax were properly arranged to help staff reduce stress. Finally, psychological counsellors regularly visited the rest area to listen to difficulties or stories encountered by staff at work, and provide support accordingly." End of Quote.
These and other relevant measures may immediately be deployed Nationwide, by all Nations that are fighting COVID-19.
6. Quote "The learning from these psychological interventions is expected to help the Chinese government and other parts of the world to better respond to future unexpected infectious disease outbreaks." End of Quote.
True, the authors have provided valuable insight into an important part of the COVID-19 containment and treatment process, which can also be utilized for any other similar outbreaks in future too.
Hope, all Nations will immediately improve or modify their processes suitably to bring these findings of the authors into the COVID-19 containment and treatment processes.
Part VII. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of Protecting health-care workers from subclinical coronavirus infection Published: February 13, 2020 DOI: https://doi.org/10.1016/S2213-2600(20)30066-7
Publons Review Link:
Post Publication Independent Review of
Protecting health-care workers from subclinical coronavirus infection
De Chang, Huiwen Xu, Andre Rebaza, Lokesh Sharma, Charles S Dela Cruz,
Published: February 13, 2020 DOI: https://doi.org/10.1016/S2213-2600(20)30066-7
1. Quote "Health-care workers face an elevated risk of exposure to infectious diseases, including the novel coronavirus (COVID-19) in China. It is imperative to ensure the safety of health-care workers not only to safeguard continuous patient care but also to ensure they do not transmit the virus" End of Quote.
The condition is the same for all Nations.
2. Quote "According to recent guidelines from the China National Health Commission, pneumonia caused by COVID-19 was included as a Group B infectious disease, which is in the same category as other infectious viruses such as severe acute respiratory syndrome (SARS) and highly pathogenic avian influenza (HPAI). However, current guidelines suggest ensuring protective measures for all health-care workers similar to those indicated for Group A infections—a category reserved for highly infectious pathogens, such as cholera and plague." End of Quore.
This indicates that the health care workers will be more susceptible to the disease. Unless they are protected, it will be very difficult to contain and treat the population.
3. Quote "Recent evidence suggests that even someone who is non-symptomatic can spread COVID-19 with high efficiency, and conventional measures of protection, such as face masks, provide insufficient protection" End of Quote.
Conventional measures of protection may be sufficient for the people who might come in contact with the disease seldom. However, conventional measures of protection may not be sufficient for health care workers who are in close proximity to the disease always, through the patient.
4. Quote " not only can subclinical patients transmit the virus effectively but patients can also shed high amounts of the virus and infect others even after recovery from the acute illness. These findings warrant aggressive measures (such as N95 masks, goggles, and protective gowns) to ensure the safety of health-care workers during this COVID-19 outbreak, as well as future outbreaks" End of Quote.
This statement needs to be given due attention, and all Nations may have to immediately manufacture on a large scale N95 masks, goggles and protective gowns for the healthcare workers and also ensure a steady supply of N95 masks, goggles and protective gowns, so that they can be changed periodically, ensuring maximum safety for the healthcare workers.
Part VIII. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of “COVID-19: the medium is the message” Published: March 11, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30600-0
Publons Review Link:
Post Publication Independent Review of
COVID-19: the medium is the message
Published: March 11, 2020
1. Quote "In a world of polarising distrust and trade tensions, the spread of coronavirus disease 2019 (COVID-19), both within nations and internationally, is aided and abetted by misinformation that circumnavigates the planet in microseconds. Such misinformation is not all malevolent, although its impact can be devastating. " End of Quote.
The statement of the authors speaks for itself.
Attention is drawn to the Migrant Labour exodus which caused the Prime Minister to intervene and apologise.
Attention is further drawn to the Tablighi Jamaat event (attracting media attention while this review is being written), which has potential for further inconvenience, due to misinformation.
2. Quote "Some have sought to limit misinformation about COVID-19 on social media by pressuring corporations, such as Facebook, Weibo, and Twitter, to censor bad actors" End of Quote.
This may be the need of hour, but it is not sure how far censure of Facebook, Weibo or Twitter will help, when the main source of information could be mainstream media, and social media only adds more color and flavour to mainstream media reporting.
3. Quote "The “truth” can, and should, change as investigations and data analysis of COVID-19 proceed, but its bottom line ought to consistently reflect empiricism, a solid dose of scepticism and scrutiny, and absolute conviction in timely dissemination of life-saving research and analysis. And those bastions must resist attempts to sway their messaging to reflect institutional or political interests." End of Quote.
Reading together with content from this research article quoted in Review Comments 1-3, along with the review comments provided in the same serial numbers, provides a "not too rosy" picture.
Accompany this with "wilful miscommunication" and "nonwilful miscommunication", the negative effects can be devastating.
Correct information should be disseminated and misinformation should be censured, to prevent negative backlashes from a population that is already suffering with a prolonged lockdown, accompanied with personal, social and misinformation stress, and a psychotic fear of the unknown due to COVID-19.
Suggested that a suitable team be put in to watch, censure and take corrective immediate action on miscommunication.
4. Quote "However, there is even less funding for professional communications staffing at WHO, the various Centers for Disease Control and Prevention in Africa, Europe, North America, and Asia, or their counterpart offices nested in local departments of public health. If the media isn't getting the message, in all likelihood the messengers have insufficient resources for delivery." End of Quote.
The authors point out a pathetic state of affairs globally.
Disease containment and treatment protocols may take center stage, but at the same time, Professional Communications and Censure of Miscommunication need to be given priority immediate attention, so that the efforts of disease containment and treatment protocols reap the success of their efforts. Polarisation of any section of the society, wilful & nonwilful noncooperation by the stressed members of the society may have a weighted negative effect. Attention is drawn to migrant labor exodus and the Tablighi Jamaat event, both of which have the potential of alienating/polarising sections of the society accompanied with wilful & nonwilful noncooperation by the stressed members of the society. If political polarisation also moves in, the effects can be more devastating.
Consequently, Professional Communications should be given a more important part in the disease containment and treatment protocols of the COVID-19 outbreak.
5. Quote "The current global COVID-19 epidemic features mechanisms of delivery of scientific information that are frankly unprecedented, adding to pressure for proper interpretation by the media and public. Scientific and medical publications are expediting research and analysis through peer review, while preprint services are publishing unreviewed work. Some researchers are engaging in open online venues, debating the calculus of crucial epidemic COVID-19 features, such as its basic reproduction number (R0), case fatality rates, age and gender distributions of severe and deceased cases, or the accuracy of case reporting, itself. Those debates have fuelled media reporting, even when the evidence is still uncertain and research is ongoing." End of Quote.
These observations by the authors strengthen the review comments presented above.
6. Quote "The difficulty in sifting fact from inaccurate information is aggravated by the speed of unfolding events, how much is still to be researched and understood by scientists and clinicians about COVID-19" End of Quote.
These observations by the authors strengthen the review comments presented above.
7. Quote "Had China allowed physician Li Wenliang and his brave Wuhan colleagues to convey their suspicions regarding a new form of infectious pneumonia to colleagues, social media, and journalists without risking sanction, and had local officials not for weeks released false epidemic information to the world, we might not now be facing a pandemic. Had Japanese officials allowed full disclosure of their quarantine and testing procedures aboard the marooned Princess Diamond cruise ship, crucial attention might have helped prevent spread aboard the ship and concern in other countries regarding home return of potentially infectious passengers. Had Shincheonji Church and its supporters within the South Korean Government not refused to provide the names and contact information on its members and blocked journalists' efforts to decipher spread of the virus in its ranks, lives in that country might have been spared infection, illness, and death. Had Iran's deputy health minister, Iraj Harirchi, and members of the country's ruling council not tried to convince the nation that the COVID-19 situation was “almost stabilised”, even as Harirchi visibly suffered from the disease while on camera, the Middle East might not now find itself in grave danger from the spread of the disease, with Saudi Arabia suspending visas for pilgrims seeking to visit Mecca and Medina. Neither Iran nor Saudi Arabia has free and open journalism, and both nations seek to control narratives through social media censorship, imprisonment, or even execution. And had the Trump administration not declared criticism of its slow response to the encroaching epidemic a “hoax”, claiming it was a political attack from the left, the US CDC might have been pressured to do widespread testing in early February, discovering pockets of community transmission before they dispersed widely." End of Quote.
The authors are now presenting observations on a case by case basis.
This post-publication review does not comment on the political observations quoted in Review 7, but seeks to draw insights that can help to improve current disease containment and treatment protocols of COVID-19.
It is quite possible that there could be deeply rooted in the observation (content quoted in Review 7), some aspect of miscommunication, which has found its way to the authors to a research article. If the miscommunication had been handled at the initial stages itself, it would not have found its way to various published content (print or electronic), and eventually into a research article. After a long time, the actual communication might have been forgotten from societal memory, but only the miscommunication may be remembered.
If the future should not bring out such or similar observations due to wilful or nonwilful miscommunication that can find its way into print & electronic media eventually landing in research articles, then it is essential that a suitable structure be put in to handle correct Professional Communications on Disease Containment and Treatment Protocols and Associated Processes.
8. Quote "If governments, agencies, and health organisations want people at risk of infection to respond to COVID-19 with an appropriate level of alert, to cooperate with health authorities, and to act with compassion and humanity, I believe that they must be willing to fund their messengers on an unprecedented scale, with genuine urgency. It's time to put information in the driver's seat of global and national epidemic responses." End of Quote.
The authors are presenting an insight here that can speak for itself and may not need a review comment.
9. Quote "When WHO named the disease COVID-19, the choice was based on scientific standards. But it also matters how the global public might use the name. COVID-19 seems to be a tough term for news media worldwide and the general public. Perhaps even more confusing to the general public is the notion that the disease and the virus (SARS-CoV-2) have seemingly unrelated monikers. Parts of the media have settled for calling the microbial threat the coronavirus. One assumption could be that no expert in communications was asked to weigh in on the namings. But had WHO given serious consideration to future control of the public narrative, the agency's communications staff would have had opportunity to capture online brands and social media monikers before public announcement, such as #COVID19 or a myriad of Facebook page names using permutations of SARS-CoV-2 and COVID-19. This was not done, and online public discourse using those tags is in private hands." End of Quote.
The authors are presenting an insight here that can speak for itself and may not need a review comment.
10. Quote "Scientists and public health leaders, from local city tiers all the way to WHO headquarters in Geneva, need to understand that press conferences and government media releases are necessary, but are not enough in the emotionally charged atmosphere of 24/7 virally distributed social media stories and news about COVID-19, laced with sensationalism, at times massaged by some government agencies, and exploited by trolls and disruptors. Getting ahead of COVID-19 requires not only slowing its spread, adequate funding for the health response, supporting research to advance our knowledge of it, integrated actions to mitigate the health, economic, and social impacts of the epidemic, among others, but also control of narratives regarding its scientific and clinical attributes and pandemic containment efforts—an effort that I do not think can be successful if executed on inadequate budgets by sleep-deprived communicators." End of Quote.
The authors are presenting an insight here that can speak for itself and may not need a review comment.
11. Quote "Social media companies like Facebook, Google, WeChat, YouTube, Amazon, and Instagram are devoting some resources to identifying and removing disease trolls and liars from their internet services. But these social media platforms remain packed with anti-science and conspiracy claims. " End of Quote.
This observation by the authors strengthen the need for a National Level Activity to disseminate authentic information, while at the same time, censuring wilful and nonwilful miscommunication.
12. Quote "Public fear in some sectors is rising as COVID-19 spreads in many countries. I propose a potential mechanism to help allay fear. " End of Quote.
This observation, if exhibited by society, has the potential to derail the good efforts undertaken for the containment and spread of outbreak of COVID-19.
13. Quote "As Canadian social analyst Marshall McLuhan put it in the 1960s, “The medium is the message”, and today that message is chaos." End of Quote.
If the observation of the authors is correct, then it can potentially derail all good activity undertaken with regard to COVID-19.
Further, the Disaster Management Bill of 2005 (Disaster Management Act of 2005) https://www.ifrc.org/Docs/idrl/512EN.pdf does not seem to discuss about Media Censure of wilful and nonwilful miscommunication, which is an immediate concern .
It is upto to the National Governments now, to create order from chaos, establish a suitable structure for communication, monitor and censure wilful and nonwilful miscommunication, identify potentially polarising (political, religious, ethnic, discriminatory, etc.) miscommunication and ensure that polarisation of society does not take place, so that the containment and treatment processes of COVID-19, and further rehabilitation/recovery of the Nation (from devastation due to COVID-19) is able to be done on a good scale.
COVID-19 and its devastation (whether it be due to deterioration of health or polarisation due to miscommunication), has the potential to make/break Governments, which will again fall back on the society as more stress in related areas, and may lead to cyclic devastating processes.
Consequently, Professional Communications needs to be given due significance in COVID-19 processes, and identification & censure of miscommunication needs to be done at microlevel, and suitable structures established to achieve it, so that the massive efforts of disease containment and treatment processes of COVID-19 may reap the success expected of their efforts.
Part IX. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of Guidelines for pregnant women with suspected SARS-CoV-2 infection Published: March 03, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30157-2
Publons Review Link:
Post Publication Independent Review of
Guidelines for pregnant women with suspected SARS-CoV-2 infection
Guillaume Favre, Léo Pomar, Xiaolong Qi, Karin Nielsen-Saines, Didier Musso, David Baud
Published: March 03, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30157-2
Quote "Consequences of infection with SARS-CoV-2 for pregnancies are uncertain, with no evidence so far of severe outcomes for mothers and infants; however, the possibility should be considered.4 The recent experience with Zika virus suggests that when a new pathogen emerges, the health-care community should be prepared for the worst-case scenario.5 Therefore, recommendations for management of pregnant women at risk of SARS-CoV-2 infection are urgently needed. To this end, we propose a detailed management algorithm for health-care providers (appendix)." End of Quote.
Appendix/Supplementary Material provided for this paper (link given below), provides a flow chart for suggested Guidelines for treating pregnant women with suspected SARS-CoV-2 infection
An algorithm for healthcare management of pregnant women is suggested by the authors as below.
1. any pregnant woman who has travelled in a country affected by SARS-CoV-2 within the previous 14 days or who has had close contact with a patient with confirmed SARS-CoV-2 infection should be tested with a SARS-CoV-2 nucleic acid amplification test,6 even if asymptomatic
2. Pregnant women with laboratory-confirmed SARS-CoV-2 infection who are asymptomatic should be self-monitored at home for clinical features of COVID-19 for at least 14 days.
3. These patients and those recovering from mild illness should be monitored with bimonthly fetal growth ultrasounds and Doppler assessments because of the potential risk for intrauterine growth restriction.
4. Pregnant women with COVID-19 pneumonia should be managed by a multidisciplinary team at a tertiary care centre.
5. When quick Sepsis-related Organ Failure Assessment criteria are met, the patient should be transferred to an intensive care unit.
6. For pregnant women with confirmed infection, the choice of delivery timing should be individualised depending on the week of gestation and maternal, fetal, and delivery conditions.
7. Whenever possible, vaginal delivery via induction of labour, with eventual instrumental delivery to avoid maternal exhaustion, should be favoured to avoid unnecessary surgical complications in an already sick patient.
8. Septic shock, acute organ failure, or fetal distress should prompt emergency cesarean delivery (or termination if legal before fetal viability).
9. Newborns of mothers positive for SARS-CoV-2 should be isolated for at least 14 days or until viral shedding clears, during which time direct breastfeeding is not recommended.
10. These recommendations should be adapted to local health-care facilities, as well as in response to any further updates on SARS-CoV-2 and COVID-19."
End of Quote.
The above recommendations may help to assist healthcare providers, pregnant women, patients and the society in suggesting/taking informed decisions, planning/implementing healthcare protocols and processes for the good of the mother and the baby.
Part X. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of Mitigate the effects of home confinement on children during the COVID-19 outbreak Published: March 04, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30547-X
Publons Review Link:
Post Publication Independent Review of
Mitigate the effects of home confinement on children during the COVID-19 outbreak
Guanghai Wang, Yunting Zhang, Jin Zhao, Jun Zhang, Fan Jiang
Published: March 04, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30547-X
1. Quote "In response to the coronavirus disease 2019 (COVID-19) outbreak, the Chinese Government has ordered a nationwide school closure as an emergency measure to prevent spreading of the infection" End of Quote
Quote "the emergency home schooling plan has been rigorously implemented.2" End of Quote
Reference 2 indicates content at link http://www.moe.gov.cn/srcsite/A06/s3321/202002/t20200212_420435.html (which might require Google Translate to view in English)
A brief look at the notification indicates a well structured suggestion for online education when schools are shut down due to COVID-19.
If any suggestion is found good, the same can be used to improve the current online education systems in Nations wherever schools are shut down due to COVID-19.
2. Quote "Massive efforts are being made by schools and teachers at all levels to create online courses and deliver them through TV broadcasts and the internet in record time. The new virtual semester has just started in many parts of the country, and various courses are offered online in a well organised manner. These actions are helping to alleviate many parents' concerns about their children's educational attainment by ensuring that school learning is largely undisrupted." End of Quote.
Though laptops or personal computers may be accessible by Children at home, internet bandwidth congestion is a factor that needs attention. However, most homes have Cable Television and schooling programs can be beamed through dedicated Cable Television Channels at both National & State Levels depending on the schooling pattern. Assignments may be given to ensure that the children actively participate in educational programs. Due to lockdown, the whole family may be at home. Consequently, educational broadcast may be planned in such a way that the children participate in the programs at prescheduled time and the others in the family can watch television at a later time. Assignments may be planned so that the children are busy with the assignments when others in the family watch Television. To balance viewership, high TRP ratings content on all channels may be shifted to different time slots so that the educational transmission will have a separate unique transmission window.
3. Quote "Although these measures and efforts are highly commendable and necessary, there are reasons to be concerned because prolonged school closure and home confinement during a disease outbreak might have negative effects on children's physical and mental health.3, 4" End of Quote.
This observation by the authors need to be given attention.
4. Quote "Evidence suggests that when children are out of school (eg, weekends and summer holidays), they are physically less active, have much longer screen time, irregular sleep patterns, and less favourable diets, resulting in weight gain and a loss of cardiorespiratory fitness.3, 5 Such negative effects on health are likely to be much worse when children are confined to their homes without outdoor activities and interaction with same aged friends during the outbreak." End of Quote.
Perhaps, some of the educational transmission may need to have live participation by the children, with some physical activity (for example floor exercises or limited exercise).
5. Quote "Perhaps a more important but easily neglected issue is the psychological impact on children and adolescents. Stressors such as prolonged duration, fears of infection, frustration and boredom, inadequate information, lack of in-person contact with classmates, friends, and teachers, lack of personal space at home, and family financial loss can have even more problematic and enduring effects on children and adolescents.4" End of Quote.
Apart from short term effects, the observation by the authors seem to indicate long term effects too.
6. Quote "the interaction between lifestyle changes and psychosocial stress caused by home confinement could further aggravate the detrimental effects on child physical and mental health, which could cause a vicious circle. To mitigate the consequences of home confinement, the government, non-governmental organisations (NGOs), the community, school, and parents need to be aware of the downside of the situation and do more to effectively address these issues immediately." End of Quote.
A multipronged approach by multiple stakeholders may be the need of the hour.
7. Quote "The government should also provide guidelines and principles in effective online learning and ensure that the contents of the courses meet the educational requirements. Yet it is also important not to overburden the students. " End of Quote.
8. Quote "The government might mobilise existing resources, perhaps involving NGOs, and create a platform for gathering the best online education courses about healthy lifestyle and psychosocial support programmes available for schools to choose from. For example, in addition to innovative courses for a better learning experience, promotional videos can be useful to motivate children to have a healthy lifestyle at home by increasing physical activities, having a balanced diet, regular sleep pattern, and good personal hygiene.8 To make these educational materials truly effective, they must be age-appropriate and attractive. They require professional expertise and real resources to create." End of Quote.
Attempting to state in a simple sentence, the lockdown and subsequent time may be very appropriate to help motivate the students and prepare them to be better citizens of the future.
9. Quote "Communities can serve as valuable resources in managing difficulties of family matters. For instance, parents' committees can work together to bridge the needs of students with school requirements and to advocate for children's rights to a healthy lifestyle. Psychologists can provide online services to cope with mental health issues caused by domestic conflicts, tension with parents, and anxiety from becoming infected.7 Social workers can play an active role in helping parents cope with family issues arising from the situation, when needed. Such a social safety net could be particularly useful for disadvantaged or single-parent families,9 but action is needed to make it accessible to them." End of Quote.
All Stakeholders need to work together cohesively.
10. Quote "Schools have a critical role, not only in delivering educational materials to children, but in offering an opportunity for students to interact with teachers and obtain psychological counselling. Schools can actively promote a health-conscious schedule, good personal hygiene, encourage physical activities, appropriate diet, and good sleep habits, and integrate such health promotion materials into the school curriculum.3" End of Quote.
In short, the lockdown period due to COVID-19, is indeed a bessing in disguise, to take a break from regular schooling system and motivate the children to evolve into better citizens of the future.
11. Quote "In the event of home confinement, parents are often the closest and best resource for children to seek help from. Close and open communication with children is the key to identifying any physical and psychological issues and to comforting children in prolonged isolation.10, 11 Parents are often important role models in healthy behaviour for children. Good parenting skills become particularly crucial when children are confined at home. Besides monitoring child performance and behaviour, parents also need to respect their identity and needs, and they need to help children develop self-discipline skills. Children are constantly exposed to epidemic-related news, so having direct conversations with children about these issues could alleviate their anxiety and avoid panic.10, 11 Home confinement could offer a good opportunity to enhance the interaction between parents and children, involve children in family activities, and improve their self-sufficiency skills. With the right parenting approaches, family bonds can be strengthened, and child psychological needs met.12" End of Quote.
Not all parents may be aware of the concerns raised by the authors. Hence, the parents also need to be taught/schooled during the lockdown period.
12. Quote "Since the COVID-19 epidemic is no longer confined to China,13 school closure and home confinement-related issues also become relevant in other affected countries. As children are vulnerable to environmental risks and their physical health, mental health, and productivity in adult life is deeply rooted in early years,14 close attention and great efforts are required to address these emergency issues effectively and avoid any long-term consequences in children. Any sustainable programme must involve local professionals to culturally adapt the interventions to the administrative system and to the regional and community environment, and it must develop contextually relevant material for children and adolescents.7 Finally, children have little voices to advocate for their needs. The latest Commission14 on the future of the world's children urges a holistic strategy in preparing for the uncertainty that all children are facing. It is the responsibility and keen interests of all stakeholders, from governments to parents, to ensure that the physical and mental impacts of the COVID-19 epidemic on children and adolescents are kept minimal. Immediate actions are warranted." End of Quote.
The authors are making significant observations here. These concerns may be suitably incorporated into existing systems so that the next generation of adults (currently children) may be provided a chance to evolve into better principled and ethical law abiding citizens of the future.
Part XI. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of Mental health considerations for children quarantined because of COVID-19 Published: March 27, 2020 DOI: https://doi.org/10.1016/S2352-4642(20)30096-1
Publons Review Link:
Post Publication Independent Review of
Mental health considerations for children quarantined because of COVID-19
Jia Jia Liu, Yanping Bao, Xiaolin Huang, Jie Shi, Lin Lu
Published: March 27, 2020 DOI: https://doi.org/10.1016/S2352-4642(20)30096-1
1. Quote "However, researchers have realised that such measures might have adverse psychological effects on children who are quarantined. For children who are quarantined at home with their parents or relatives, the stress caused by such a sharp change in their environment might be eased to some degree.2" End of Quote.
Authors suggest that quarantine may have adverse psychological effects on children. However, stress of those children who are quarantined at home with their caregivers, may be eased. Authors are citing as Reference 2, Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet. 2020; (published online March 4.) https://doi.org/10.1016/S0140-6736(20)30547-X , post publication review of which is available as Part X. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of Mitigate the effects of home confinement on children during the COVID-19 outbreak Published: March 04, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30547-X at https://www.prabhubritto.org/post-publication-independent-reviews-covid-19
2. Quote "However, children who are separated from their caregivers require special attention, including children infected with or suspected of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), who are quarantined in local hospitals or collective medical observation centres; and children whose caregivers are infected with SARS-CoV-2 or who have died from the disease and are thus under the care of social charity groups. These children might be more susceptible to mental health problems because of their higher risk of infection, and the grief and fear caused by parental loss or separation." End of Quote.
The authors are bringing out a perspective that needs priority care and concern by the Govt., as they are children.
3. Quote "children who were isolated or quarantined during pandemic diseases were more likely to develop acute stress disorder, adjustment disorder, and grief." End of Quote
Quote "separation from parents or parental loss during childhood also has long-term adverse effects on mental health, including a higher risk of developing mood disorders and psychosis, and death by suicide in adulthood.6, 7" End of Quote.
The Ministries of Health & Family Welfare and Women & Child Development may have to set up a unique multidisciplinary taskforce along with active participation by Societal Service Organizations, Professionals & Individuals to give the children medication, nutrition, care, love & affection, psychological support, schooling and nurturing so that they are helped to cope up with separation from parents or parental loss during childhood (due to COVID-19). Perhaps, these children may be adopted by the Nation.
Part XII. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of Refugee and migrant health in the COVID-19 response Published: March 31, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30791-1
Publons Review Link:
Post Publication Independent Review of
Refugee and migrant health in the COVID-19 response
Hans Henri P Kluge, Zsuzsanna Jakab, Jozef Bartovic, Veronika D'Anna, Santino Severoni
Published: March 31, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30791-1
1. Quote "Measures to respond to the COVID-19 pandemic are a focus of communities in countries, but preparedness plans should consider refugees and migrants and their needs. Evidence shows that this vulnerable population has a low risk of transmitting communicable diseases to host populations in general.4 However, refugees and migrants are potentially at increased risk of contracting diseases, including COVID-19, because they typically live in overcrowded conditions without access to basic sanitation. The ability to access health-care services in humanitarian settings is usually compromised and exacerbated by shortages of medicines and lack of health-care facilities. Moreover, refugees typically face administrative, financial, legal, and language barriers to access the health system.4" End of Quote.
The authors are putting forward a point of concern, which may require coordinated activity from multiple facets of Govt. Agencies to handle this concern, especially with relation to the COVID-19 outbreak.
Authors are citing reference 4, which is a WHO report titled "Report on the health of refugees and migrants in the WHO European Region: no public health without refugee and migrant health (2018)" available at http://www.euro.who.int/en/publications/html/report-on-the-health-of-refugees-and-migrants-in-the-who-european-region-no-public-health-without-refugee-and-migrant-health-2018/en/index.html
1a. The WHO report also brings out points of concern.
Quote "In addition, and with the aim of harmonizing refugee and migrant health policy globally, WHO is now preparing a global action plan on the health of refugees and migrants, in line with the health dimensions of the United Nations Global Compact on Safe, Regular and Orderly Migration and the Global Compact for Refugees, in close collaboration with the International Organization for Migration, UNHCR, other partner international organizations, Member States and other relevant stakeholders, as well as refugees and migrants themselves.
Refugees and migrants enjoy the same human right to health as everyone else. One key priority is enhancing social protection for refugees and migrants, including developing sustainable financial mechanisms, both nationally and internationally, to provide for universal health coverage and social protection. Another key priority is reducing the xenophobia, discrimination and stigma often experienced by refugees and migrants, through actions such as advocacy and evidence-informed communication with both refugee and migrant communities and host populations.
These high principles provide the background to this report, which shows the progress made so far in responding to these health challenges, and what more needs to be done. I am delighted that the WHO European Region has led the way, and I hope that this report will inspire yet more progress in the coming months and years.
WHO Regional Director for Europe" End of Quote
Reading the WHO report with the following article from the Indian Express, https://indianexpress.com/article/cities/mumbai/maharashtra-residents-dont-want-shelter-homes-for-migrants-in-their-areas-claim-it-puts-them-at-risk-6337688/ seems to indicate that some concerns raised in the WHO report may be valid in INDIA too.
Suggested that INDIA may lead the world in establishing a separate new Department for Migrants & their welfare, which can also serve as a Nodal Agency for all concerns regarding Migrants, inclusive of content in news-item at https://www.ndtv.com/india-news/shut-down-public-interest-litigation-shops-centre-to-supreme-court-2205739 , so that the other teams entrusted with assignments on handling the COVID-19 outbreak can continue their service without hassles, while the new Department for Migrants can help ensure social protection, sustainable financial mechanisms, universal health coverage, including relief and care during such outbreaks as the COVID-19 and further attend to legal aspects too.
2. Quote "Basic public health measures, such as social distancing, proper hand hygiene, and self-isolation are thus not possible or extremely difficult to implement in refugee camps. If no immediate measures to improve conditions are put in place, the concern about an outbreak of COVID-19 in the camps cannot be overstated. Site-specific epidemiological risk assessments must be done to determine the extent of the risk of COVID-19 introduction and transmission in such settlements, together with case management protocols and rapid deployment of outbreak response teams if needed." End of Quote.
Quote "Additionally, states of emergency and lockdowns to deal with the pandemic have affected refugee and migrant volunteer community service provision for this population group." End of Quote
The authors observations may need to be given attention.
3. Quote "As governments tighten border controls and implement other measures in response to COVID-19, they need to consider the impacts on refugees and migrants and ensure that such actions do not prevent people from accessing safety, health-care services, and information." End of Quote.
Quote "There must be no forced returns and refoulement justified by or based on fears or suspicion of COVID-19 transmission, especially because there is estimated to be low risk of transmitting communicable disease from refugee and migrant populations to host populations in the WHO European region.4 Yet migrants and refugees are often stigmatised and unjustly discriminated against for spreading disease and such unacceptable attitudes further risk wider public health outcomes, including for host populations, since refugees and migrants could be fearful to seek treatment or disclose symptoms.6" End of Quote.
Quote "Refugees and migrants must be included in national public health systems, with no risk of financial or legal consequences for them. This approach is of the utmost importance, as there can be no public health without refugee and migrant health." End of Quote.
In short, the suggestions of the authors may have to be handled by the Ministry of Social Justice & Empowerment. Consequently, the new Department for Migrants & their Welfare (outcome of Review Comment 1a) may be part of the Ministry of Social Justice & Empowerment.
Part XIII. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Medicine: before COVID-19, and after" Published: March 31, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30756-X
Publons Review Link:
Post Publication Independent Review of
Medicine: before COVID-19, and after
Published: March 31, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30756-X
Though this research article is titled "Medicine: before COVID-19, and after", it does touch upon some aspects hitherto not reported in any research article. This research article makes an interesting read, compared to the monotony of COVID-19 handling processes & protocols found in many research articles that dealt with COVID-19. Perhaps, this research article may be a call for an awakening too, at National & Global Levels. Consequently, this post publication review has a Prologue and an Epilogue too, out of respect for the views expressed by the Authors.
1. Quote "Global pandemics reach us all. As a species, it seems that we are slightly stunned by our lack of autonomy over this pandemic. Celebrities and billionaires are not immune, despite reports of their escape to yachts, private islands, private testing, and an endless supply of hazmat suits. But, of course, the poor always come off worst, and there is no reason to think this will be an exception." End of Quote.
The authors call for an introspection, coz, when everyone is at risk and none is immune, what is the point in being self-centred? Perhaps, it would be good if people reduce their self-centredness and embrace the whole of humanity and the animal kingdom, so that every life may have a fair chance to live.
2. Quote "There is another side, of course. People are organising, street by street, to make sure that self-isolators are safe and fed. Medical students are offering to look after children to let their health-care worker parents get to work. Maybe “Big Society” is really little society, doorstep to windowsill. Red tape has been evaporated in some places as homeless people have been offered free accommodation. Some supermarkets are opening earlier to let vulnerable people or health-care staff get necessary food. People have applauded their health-care workers." End of Quote.
The less fortunate (compared to Celebrities and Billionaires) seem to have attempted to help give every life a fair chance to live.
3. Quote "And perhaps people are becoming more aware of the environmental risks of human behaviour. The absence of people doing non-essential manufacturing and travel has resulted in a sharp drop in pollution. The possible expected reduction of pollution-related disease might make us question what life should look like once we are over the worst. We are guests on this planet. If only we took climate change as seriously and acted as swiftly. Could we imagine lockdowns to protect the planet? But slow deaths do not make headlines like frighteningly fast, pandemic ones." End of Quote.
The authors have a valid point here. If we could have a periodic lockdown, Nature and the World might heal periodically, thereby blessing mankind with better living conditions on the Planet. This is a call that the Governments of Nations have to take. Let us hope that atleast one Govt. in the World, might lead by planning a periodic annual lockdown to help heal the planet, which might consequently provide better living conditions for mankind.
4. Quote "Now many people in the UK are looking admiringly to the NHS, respectfully asking experts for advice, and paying homage to professionalism." End of Quote.
Atleast until this pandemic passes, Experts & Professionals may be looked upon with respect and their advice heeded. Wouldnt the world be a better place to live, if Experts & Professionals are given the same respect all the time, instead of giving respect only in life-threatening situations?
5. Quote "I have noted how many patients, at the end of consultations, ask us to stay safe. Last week, after an overwhelmingly busy day, making multiple, pressured decisions with far less information than I would have liked, this consideration almost made me cry." End of Quote.
Humanity seems to blossom on the Planet??? Unexpected gratitude from unexpected or unable to be expected quarters may make the human tender.
6. Quote "There is perhaps an opportunity for us to capture, now. It might be one route to banish systemic tendencies to create overtreatment." End of Quote
Quote "Divisions between departments seem to have been subsumed with common purpose, good will, and urgency. We have also been talking more with colleagues. Freed from routine work that atomises my colleagues to separate screens behind closed doors, we have been talking, debating, and discussing more often and in one place. Staff have been willing to work extra shifts. The trick will be to realise this and make sure we respect the meaning of it, and keep it. A resurgence in trust in professionalism seems to have given us permission to finally disregard low-value bureaucratic work. Instead, the priority is organising to give the best care we can to the people who need it most." End of Quote.
Quote " That it has taken a global crisis, which is killing patients and health-care staff, and which will have profound psychological sequelae, to make this happen, is catastrophic, and an unpayable price. This is likely to be a divide in the global history of medicine. I can only hope that professional collegiality and solidarity will get us through." End of Quote.
There seems to be some unexpected good happening in multiple facets (though it could have happened as an offshoot of the COVID-19 containment and treatment processes), and it might be in the good interests of the people of the World to let the good happenings continue.
Let mankind continue to exhibit humanity, collegiality and solidarity, helping everyone to have a fair chance to live. Let this pandemic help us to learn that no amount of riches nor fame can make us immune to diseases like COVID-19, and everyone has the same risk of fatality whether it be a human born with a silver spoon, or a homeless human on the street. When all of us can have the same risk and none can have better immunity against diseases like COVID-19, why not human beings learn to be more humane, share resources with fellow human beings, animals and other life forms, and let everyone have a fair chance of life, consequently improving life for the self also? Will any Govt. or Nation take the lead and help to make life better for all, or will none bother about it once the COVID-19 pandemic is past? Or human beings will be more humane only under life-threatening disease conditions like COVID-19? Will there be any National Leader who will take it upon himself/herself, and emerge as a new beacon of hope for the entire planet? Or will there be teams of National Leaders, who will help sustain the goodness & humanity that has emerged during the times of COVID-19 to continue forever? Time alone can answer these questions, while hope can be sustained that goodness & humanity (found enhanced during COVID-19) will continue, past the COVID-19 too.
Is INDIA showing the way for the World !!! Part XIV. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of SARS-CoV-2: a time for clear and immediate action
Publons Review Link:
Post Publication Independent Review of SARS-CoV-2: a time for clear and immediate action. Published: March 31, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30250-4
1. The following statements can be treated as a Prologue by the Authors.
Quote "I have spent a 33-year career studying respiratory RNA viruses, devising vaccine approaches against them, and unravelling the human immune response to these viruses and vaccines, as well as promoting policies to minimise their effects. Over the past 10 weeks, I and many others have been in the thick of explaining what we know about coronaviruses and other respiratory viruses, and extrapolating this knowledge to understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to many health-care providers, organisations, media, and lay people. I have watched the rapid transmission of this virus across continents and around the globe. Based on the alarming rate of disease—along with my experience with RNA respiratory viruses—and what we are now observing in the USA and around the world, I have concluded that we must do what we do not want to do." End of Quote.
2. The authors are presenting the background or fundamental information subsequently.
Quote "To be clear, none of us, me included, have a crystal ball; however, we do have the benefit of history, genetics, virology, and current epidemiology to guide us. We have seen rapid transmission of this virus, with concomitant high rates of severe disease and associated mortality, across many countries in real time. We understand more about viral reproductive number, generation time, incubation period, transmission modes, and the effect on health-care systems across multiple countries. The numbers of cases appear to be doubling roughly every 3–4 days in multiple countries. We do not have antivirals, vaccines, antibody-based therapeutics, or specific treatments. We can only offer supportive care—after the fact." End of Quote.
3. The authors seem to be suggesting a global lockdown.
Quote "Therefore, our only reasonable option is to maximally decrease viral transmission by maximally decreasing the opportunity for face-to-face interaction. In this regard, I believe that we as a global community should enter into a period of contextually appropriate suspension. The idea is to suspend all activities that are not absolutely essential and that involve face-to-face interactions and group gatherings. It is apparent from the kinetics of SARS-CoV-2 transmission, the rapidly growing number of cases, the increasing involvement of more and more countries and regions within those countries, and the surge of demand on an already maximum capacity and frequently overstressed medical system, that this lockdown is the safest course of action. " End of Quote.
4. The authors now provide a defense for suggesting a global lockdown.
Quote " I believe this action is necessary for various reasons.
First, we have an increasingly older age demographic across virtually all countries, as well as unprecedented rates of obesity, smoking, diabetes, and heart and lung disease, and an ever-growing population of people who are immunocompromised—all comorbidities that lead to significantly higher risks of severe disease and death from coronavirus disease 2019 (COVID-19). In turn, these huge numbers of people who are more severely affected by this virus require ongoing and more complex care, overwhelming many times over the capacity of medical systems to care for them. In turn, this high demand sharply drives up mortality rates while vital supplies, specialists, intensive care unit (ICU) beds, ventilators, and medicines are depleted. We have seen the worse effect of this virus in societies with older age demographics such as Italy compared with South Korea, which has a higher proportion of young people.
Second, tremendous numbers of people, from all over the world, travel throughout the globe. The UN World Tourism Organization estimates that well over 1·5 billion people travel internationally each year—more than 4 million people per day. This movement and the mixing of people act as powerful accelerant fuel for this pandemic.
Third, these large numbers of people also allow for mixing of people of all ages and all medical conditions; in particular, the mixing of children and younger adults (who can be infected and might have few or no symptoms) and older adults, which further accelerates the opportunity for older adults, who suffer disproportionately, to become infected. "
End of Quote.
5. The authors then explain a lockdown will help in COVID-19 containment.
Quote "The most important manoeuvre is to immediately decrease the risk of further human-to-human viral transmission. The idea is to drive down the opportunity for an infected person to transmit the virus to another uninfected person, in essence forcibly reducing the reproductive number of the virus. To achieve this reduction requires the suspension of all non-essential gatherings that provide opportunity for spread of the virus, including suspending travel, enacting school closures, cancelling social, church, or sports-related gatherings, and working from home wherever possible. In short, staying home.
Putting these measures into place provides the opportunity to dramatically curb the speed at which the virus infects others. By flattening the epidemic curve, fewer people become ill at once, which dramatically decreases the surge in demand for medical care. For example, consider a community with a hospital that has 250 beds. Such a hospital has a small number of doctors, nurses, and other medical care personnel, as well as the necessary supplies to care for those who are ill. Such a hospital may have five to ten ICU beds and a very small number of ventilators. If five people get severely ill each week, they can probably be managed, with low rates of mortality. If 20 or 50 or 100 people become severely ill each week, the hospital and medical care system will be overwhelmed and the corresponding mortality rate will dramatically rise.
Decreasing viral transmission, and therefore infection rates, is likely to decrease viral mutational rates, and increases time for the possible development of antiviral, monoclonal, and polyclonal therapies as well as vaccine countermeasures.
Decreasing and spreading out high rates of illness, which results in a significantly lower mortality rate among those who do become ill, allows for resupply of crucially needed items to care for the ill, including personal protective equipment for health-care providers." End of Quote.
6. Quote "I recognise that many will reject such a call to action, often because of not wanting to be inconvenienced, other financial and political agendas, the resulting disruption, and not wanting to do what is inherently counter to our nature." End of Quote.
This research article has been published on March 31, 2020. India is under National Lockdown since March 24 for a period of 21 days https://pib.gov.in/newsite/PrintRelease.aspx?relid=200655
7. Quote "It seems in the current situation that people either panic or they dismiss the risk." End of Quote.
India is able to manage the National Lockdown, and people have neither panicked nor dismissed the risk by violating the National Lockdown.
8. Quote "It is inevitable at this point that this pandemic will get much worse before it gets better. For this reason, the willingness to take whatever actions are necessary to weather this pandemic while protecting the health and welfare of the maximum number of people possible—all while slowing down the explosive transmission and consequences of this virus—is what we must do. Now." End of Quote.
Reading together the review comments above, it can be understood that the authors are suggesting a global lockdown by all Nations, similar to the National Lockdown by India for a 21 day period since March 24.
Is INDIA showing the way for the World !!! Are the researchers suggesting the Indian National COVID-19 lockdown to be followed by all Nations to contain the spread of COVID-19 !!!
The WHO was looking upto INDIA for strategies in containing the spread of COVID-19 https://www.rediff.com/news/report/india-should-show-the-way-who-on-covid-eradication/20200324.htm
Has INDIA shown the way for the world and fulfilled the expectations of the Global Community on INDIA !!!
Part XV. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of Protecting the psychological health of children through effective communication about COVID-19
Publons Review Link:
Post Publication Independent Review of
Protecting the psychological health of children through effective communication about COVID-19
Louise Dalton, Elizabeth Rapa, Alan Stein Published: March 31, 2020 DOI: https://doi.org/10.1016/S2352-4642(20)30097-3
1. Quote "In this rapidly changing situation, media and social conversations are entirely dominated by the outbreak, and children are exposed to large amounts of information and high levels of stress and anxiety in the adults around them. Simultaneously, children are experiencing substantial changes to their daily routine and social infrastructure, which ordinarily foster resilience to challenging events.1 End of Quote.
Quote "children as young as 2 years are aware of the changes around them.2 Children's understanding evolves throughout childhood and adolescence. Thus, when adults talk to children, the information provided needs to take into account the child's age and level of understanding. Sensitive and effective communication about life-threatening illness has major benefits for children and their family's long-term psychological wellbeing.2" End of Quote.
The authors point out that COVID-19 management processes will also have to take Children into account.
2. Quote "Children need honest information about changes within their family; when this information is absent, children attempt to make sense of the situation on their own.3 Consideration of the child's developmental stage is crucial to ensure that communication is effective and neither underestimates or overestimates their understanding.4 Communicating with younger children should not solely rely on simplification of the language or concepts used, but must also take into account children's comprehension of illness and causality. " End of Quote.
The authors observation indicates that Communication to Children should also be a part of the COVID-19 management processes. It is not sure whether all parents will have the necessary knowledge and skill to translate health information about a pandemic such as COVID-19 and hand it over to the Children.
3. Quote "listening to what children believe about COVID-19 transmission is essential; providing children with an accurate explanation that is meaningful to them will ensure that they do not feel unnecessarily frightened or guilty." End of Quote.
If this has to be done successfully, then some prior training have to be given to parents via mass media, so that they can interact with the Children, listen to them and read alarm indicators at initial stages itself.
4. Quote "Adults' preoccupation with the implications of COVID-19 might compromise their ability to sensitively recognise and respond to children's cues or distress.7 Children are well attuned to adults' emotional states; exposure to unexplained and unpredictable behaviour is perceived by children as a threat, resulting in a state of anxiety." End of Quote.
These effects may affect the children's psychology and may continue to manifest into their adult life too, as a consequence of accidental or unintentional carry over of anxiety due to threat perception over unexplained and unpredictable behaviour. When the COVID-19 pandemic is exhibiting itself on a global scale, even at the National Level, such phenomena in children is a cause for concern and may need preventive & remedial measures.
5. Quote "Although adults often want to know how children are feeling, adults often do not set an example by sharing some of their own feelings, and conversations might well be dominated by the practical aspects of illness.2 Research has highlighted that parents sometimes specifically use technical or factual language to try and minimise their children's distress.8 An absence of emotion-focused conversations might leave children anxious about the emotional state of the adults around them. This anxiety can inadvertently result in children's avoidance of sharing their own concerns in an attempt to protect others, leaving children to cope with these difficult feelings alone.2"End of Quote.
The authors have provided a rational analysis here. However, the consequence that children are left to cope with difficult feelings alone, may have a significant impact on their psychology.
6. Quote "Adults need to be authentic about some of the uncertainty and psychological challenges of the pandemic, without overwhelming children with their own fears. This honesty not only offers a coherent explanation for what children are observing, but also grants permission for children to safely talk about their own feelings. Normalising their emotional reactions and reassuring children about how the family will look after each other helps to contain anxiety and provides a shared focus." End of Quote.
The authors have pointed out a significant concern. But, adults need to be educated on these aspects and not all adults can be expected to have a sensitive and rational understanding and the ability to convey it to the children. Consequently the burden of educating the Adults regarding interacting with the Children about the COVID-19 pandemic, falls on the Govt. The Govt. has to find ways and means, via mass outreach programs of Television or Social Media to educate the Adults on these sensitive topics.
7. Quote "Providing information9 and prioritising communication with children about COVID-19 is an essential component of any universal, community-led response to the pandemic. Health-care workers are experiencing unprecedented demands caring for a predominantly adult patient population, magnifying the invisibility of children's urgent psychological needs. However, ignoring the immediate and long-term psychological effects of this global situation would be unconscionable, especially for children and young people, who account for 42% of our world's population.10" End of Quote.
The authors are providing the defense here for their analysis, research findings and suggestions given above. When Children make up 42% of the world's population, there arises a priority need to cater to their psychological health, apart from clinical health and related processes. It is this 42% which will soon grow into adults. If the psychological effects of the COVID-19 pandemic are carried by the children into their adolescence and later into their adult stages, the collective effects on the Nation and the World may be devastating.
Consequently, a priority need arises for the Govt. to handle the above concerns related to Children on a war-footing, accompanied with other high priority processes and protocols of the COVID-19 nationwide management.
Part XVI. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Near telemedicine in general practice during the COVID-19 pandemic"
Publons Review Link:
Post Publication Independent Review of
Near telemedicine in general practice during the COVID-19 pandemic
Sohaib R. Rufai, NIHR Doctoral Fellow ST4 in Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust
Tania A. Rufai, GPST2, Medway NHS Foundation Trust, Medway NHS Foundation Trust
23 March 2020
British Journal of General Practice
1. Quote "General practitioners (GPs) may be at particular risk of contracting COVID-19 when seeing patients in the primary care setting, due to face-to-face consultations often in confined spaces.4 Longer exposure time likely increases risk of transmission.5 The Royal College of General Practitioners (RCPG) has suggested video or telephone consultations where possible,6 but these are not feasible when physical examination is required." End of Quote.
The authors are addressing a priority need of the hour, in attempting to protect General Practitioners (GPs) from human-human transmissions of COVID-19 during patient examination. This may extend to other health service professionals who come into close contact with symptomatic patients and asymptomatic carriers.
2. Quote "We propose the following near telemedicine protocol for GPs – a modified version of that recently proposed by Gunasekera for ophthalmologists7" End of Quote.
The authors are proposing a modified version of the near telemedicine protocol for General/Nurse Practitioners when examining symptomatic patients and asymptomatic carriers.
The steps are outlined as follows:
2a. Quote "A telephone or video triage with a GP or nurse practitioner can determine whether physical examination is required.
2b. If required, the patient is given an appointment to attend the surgery.
2c. The patient enters Room 1 with a freestanding tablet on a video call with the GP, who is sitting in Room 2 separately. 2d. The GP explains they will perform the majority of the consultation over the tablet and only enter Room 1 to perform physical examination, during which talking is only allowed at the discretion of the GP.
2e. After taking the history, the GP dons personal protective equipment (PPE), enters Room 1 to perform physical examination, then exits the room.
2f. The GP finishes the video consultation from Room 2 and, where required, leaves a prescription outside Room 1 for the patient to collect on departure."
End of Quote.
3. Quote "This protocol could substantially cut down the face-to-face component of GP consultations, thereby limiting exposure time. This could also be implemented across a range of specialties wherever there is a division in time between consultation and physical examination. We acknowledge that not all providers may have the required room space and equipment to implement this protocol. However, wherever possible, we hope this protocol could limit the transmission of COVID-19 and help protect healthcare professionals and patients." End of Quote.
The authors provide an insight regarding the effect of the modified version of the near telemedicine protocol for General/Nurse Practitioners in substantially limiting the exposure time with relevance to human-human transmission of COVID-19.
Since the infrastructure/establishment suggested by the authors may not involve a heavy expenditure, but at the same time reduce/limit the exposure of the General/Nurse Practitioners to COVID-19, the authors' suggestion of modified version of the near telemedicine protocol for General/Nurse Practitioners may be implemented at National Level so that the General/Nurse Practitioners may not succumb to the disease, due to which the entire National Level containment and treatment processes of COVID-19 could even be stressed out.
Part XVII. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "The COVID-19 response must be disability inclusive" Open Access Published: March 27, 2020 DOI: https://doi.org/10.1016/S2468-2667(20)30076-1
Publons Review Link:
Post Publication Independent Review of
The COVID-19 response must be disability inclusive
Laura B Nellums
Open Access Published: March 27, 2020 DOI: https://doi.org/10.1016/S2468-2667(20)30076-1
"People Living With Disabilities (PLWD), including physical, mental, intellectual, or sensory disabilities, are less likely to access health services, and more likely to experience greater health needs, worse outcomes, and discriminatory laws and stigma.2 COVID-19 threatens to exacerbate these disparities, particularly in low-income and middle-income countries, where 80% of PLWD reside, and capacity to respond to COVID-19 is limited.3, 4 Preparedness and response planning must be inclusive of and accessible to PLWD, recognising and addressing three key barriers."
End of Quote.
Quote "First, PLWD might have inequities in access to public health messaging. " End of Quote
Quote "Second, measures such as physical distancing or self-isolation might disrupt service provision for PLWD, who often rely on assistance for delivery of food, medication, and personal care" End of Quote
Quote "Third, PLWD might be at increased risk of severe acute respiratory syndrome coronavirus 2 infection or severe disease because of existing comorbidities, and might face additional barriers to health care during the pandemic.2" End of Quote
The authors are highlighting the concerns of People Living With Disabilities (PLWD), who need assistance for their daily activities. In times of lockdown and physical distancing, when the normal human being faces inherent difficulties in daily life, the PLWD will face a more acute distress in fulfilling their daily activities.
2. Quote "COVID-19 mitigation strategies must be inclusive of PLWD to ensure they maintain respect for “dignity, human rights and fundamental freedoms,”5 and avoid widening existing disparities. This necessitates accelerating efforts to include these groups in preparedness and response planning, and requires diligence, creativity, and innovative thinking, to preserve our commitment to UHC, and ensure people living with disabilities are not forgotten." End of Quote.
The insights provided by the authors call for a Nation wide effort by the Govt. to include PLWD and organizations in service of PLWD into the COVID-19 containment and treatment protocols, so that the PLWD may have a dignified life in times of National Lockdown and Physical Distancing.
3. Suggestions provided by the authors include the following:
Quote "All communication should be disseminated in plain language and across accessible formats, through mass and digital media channels. Additionally, strategies for vital in-person communication must be safe and accessible, such as sign language interpreters and wearing of transparent masks by health-care providers to allow lip reading" End of Quote.
Quote "Mitigation strategies should not lead to the segregation or institutionalisation of these individuals. Instead, protective measures should be prioritised for these communities, so care workers and family members can continue to safely support PLWD, who should also be enabled to meet their daily living, health care, and transport needs, and maintain their employment and educational commitments." End of Quote
Quote "Health-care staff should be provided with rapid awareness training on the rights and diverse needs of this group to maintain their dignity, safeguard against discrimination, and prevent inequities in care provision." End of Quote.
These are only generic guidelines suggested by the authors. However, there may be additional concerns that may arise due to demographic and ethnic variations.
A better option would be to bring the PLWD under the Ministry of Social Justice & Empowerment and attend to them via dedicated channels of the Govt.
Part XVIII. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Making decisions to mitigate COVID-19 with limited knowledge" Published: April 07, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30280-2
Publons Review Link:
Post Publication Independent Review of
Making decisions to mitigate COVID-19 with limited knowledge
Published: April 07, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30280-2
1. Quote "In their Comment, Yonghong Xiao and Mili Estee Torok1 rightly stated that infection prevention and control measures should be based on sound scientific principles. However, we disagree with the authors' views on certain measures that they consider to have “no scientific basis and have proven to be ineffective”. A difference exists between measures with unknown effectiveness and those that have been proven ineffective or of no value." End of Quote.
The authors here are triggering a rational thought process that needs to be applied (on every aspect) when dealing with pandemics like COVID-19.
Everyone may have the acceptance that infection prevention and control measures need to be based only on sound scientific principles. However, there can always exist a possibility that some measures may be quite effective, but have not been investigated thoroughly using scientific methods. When a pandemic like COVID-19 erupts, and when it takes sufficient time to even analyse and understand how the infection can be prevented and controlled, it is sure that there can always be some effective measures that have not been investigated and proved significant immediately. Prevention and Control Measure may be carried out based on only those methods which are tested scientifically. There will always be a fatality rate, though the numeric value of the fatality rate could vary based on various factors.
Consider the following situation.
methods which have not been scientifically tested currently,
are tested in due course of time and
in case if
they yield better life saving results compared to current effective methods, and
prove themselves superior in life saving compared to current effective methods
is there any provision to reverse time, bring back to life all those who are dead due to COVID-19 and restart treatment?
It is not possible.
Hence the consequent significance to the Authors' Statement "A difference exists between measures with unknown effectiveness and those that have been proven ineffective or of no value".
Hence, prevention and control measures with unknown effectiveness should be given due consideration, though caution can be exercised.
2. As an illustration and to prove their point, the authors are presenting a case as follows.
Quote "We disagree with Xiao and Torok's view that “the practice of blocking traffic and lockdown of villages is of no value for the prevention and control of COVID-19”. One of the references provided to support this statement was a local transport authority policy reported in a newspaper, which should not be considered as scientific evidence. Several studies have been done to assess the effectiveness of travel restrictions,2, 3 and the benefit of such restrictions might vary in different settings. Further studies and more data are required to reach a solid conclusion."
End of Quote
Earlier, it wasnt proved scientifically that blocking traffic and lockdown of villages would help in pandemic control. Reference 2 and 3 cited by the author are research articles published on March 6 and March 11, 2020. Consequently, upto March 6, 2020 and March 11, 2020, blocking traffic and lockdown of villages had no scientific merit in controlling the COVID-19 outbreak. But after March 6, 2020 and March 11, 2020, blocking traffic and lockdown of villages had scientific merit.
Compare this with the Nation-wide lockdown in India to control COVID-19 outbreak. Statistics of COVID-19 spread seems to indicate that Nation-wide lockdown is better that lockdown of villages (as indicated in Reference 2 and 3). But these statistics are available only in the last few days of March 2020 and in the first fortnight of April 2020 (while this review was written on April 12, 2020).
If the Indian statistics of COVID-19 containment due to Nationwide lockdown was available earlier, then Nationwide lockdown may have become the gold standard for containing pandemic outbreak. Now, a look at the Quoted text in this review comment will help to understand better.
Consequently, the authors of this research article are right in stating that prevention and control measures with unknown effectiveness should be given due consideration.
3. As a fallout of the above, the authors are calling to attention a concern in COVID-19 treatement.
Quote "With regard to hospital treatment of patients with COVID-19, Xiao and Torok suggested that patients should not be given drugs of unknown efficacy. However, considering that no treatments are known to be effective at present, we believe that off-label or compassionate use of drugs should be considered ethical, especially for patients with life-threatening infections. However, when considering off-label or compassionate use of drugs, the safety profile of the drug should be clear and the clinicians should carefully balance the risk and potential benefit of use" End of Quote.
Reading together Review Comments 1 & 2, and considering the symptomatic changes that happen in a patients biological systems due to incidence of COVID-19, the suggestion by the authors that "compassionate use of drugs should be considered ethical, especially for patients with life threatening infections" assumes a lot of significance.
Compassionate use of drugs is never recommended, and the rule book alone is followed. But, the authors make an earnest entreaty, that when the patient is suffering from infections that are life-threatening due to a pandemic like COVID-19 (over which previous scientific knowledge does not exist, and scientific knowledgebase is currently getting built up), compassionate use of drugs may be considered ethical and consequently permitted to be used.
At the same time, compassionate use of drugs cannot be given a blanket permission but can be given only on a case by case basis.
4. Quote "During this urgent phase of the COVID-19 pandemic, decisions at the level of the public health response or clinical management have to be made using the scarce data available. Scientific evidence will be gradually established as a result of ongoing research. However, measures that have good rationale, but for which little data are available, should also be considered as options and should be assessed and amended in a continuous manner."
End of Quote.
Read together with Review Comment 3, compassionate use of drugs and other clinical/medical decisions at the level of public health response or clinical management may need to be provisioned.
Suggested that a "call-centre" type of service may be provisioned, with the first level of access manned by junior doctors, healthcare professionals, paramedics, counsellors/psychiatrists, emergency professional etc., who can then divert the call to appropriate agencies or secondary/tertiary level of medical experts for decisions and suggestions. If necessary, the tertiary level can escalate to the Core Teams handling COVID-19 National Level Protocols. Access can be provided to the general public
This call-centre may be provisioned at the mobile distress dialling code 112, so that all distress calls arising during COVID-19 containment & treatment time may uniformly via all channels be routed to the call-centre which also can serve as National Emergency Response Call Centre during current COVID-19 outbreak and be re-convened in future whenever required for any time of National Level Emergency Response.
Part XIX. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "COVID-19, school closures, and child poverty: a social crisis in the making" Open Access Published: April 07, 2020 DOI:https://doi.org/10.1016/S2468-2667(20)30084-0
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Post Publication Independent Review of
COVID-19, school closures, and child poverty: a social crisis in the making
Wim Van Lancker, Zachary Parolin
Open Access Published: April 07, 2020 DOI:https://doi.org/10.1016/S2468-2667(20)30084-0
1. Quote " Although scientific debate is ongoing with regard to the effectiveness of school closures on virus transmission,1 the fact that schools are closed for a long period of time could have detrimental social and health consequences for children living in poverty, and are likely to exacerbate existing inequalities. " End of Quote.
The authors point out a significant concern in National / International interests, where fair chance is denied to children due to poverty, which might consequently affect National / International Growth of the future, when the Children grow into adults, for it is not possible to assess a Child's futuristic contribution to the Nation or the World, while being a Child.
2. Quote "For many students living in poverty, schools are not only a place for learning but also for eating healthily. Research shows that school lunch is associated with improvements in academic performance, whereas food insecurity (including irregular or unhealthy diets) is associated with low educational attainment and substantial risks to the physical health and mental wellbeing of children.2, 3 " End of Quote.
The authors observation speaks for itself. Suggested to be read together with https://www.theguardian.com/education/2020/mar/09/charities-feed-children-if-coronavirus-shuts-uk-schools
It would be in the Nation's interest to ensure that Children are provided nourishing food.
3. Quote "research suggests that non-school factors are a primary source of inequalities in educational outcomes. The gap in mathematical and literacy skills between children from lower and higher socioeconomic backgrounds often widens during school holiday periods.5 " End Quote.
Children from lower socio economic backgrounds may not have the privileges and facilities that those from higher socio economic backgrounds have. Consequently, some steps may have to be taken in the National interest to narrow the inequalities in educational outcomes through channels that are accessible by all children irrespective of differences in socio economic backgrounds.
4. Quote "Beyond the educational challenges, however, low-income families face an additional threat: the ongoing pandemic is expected to lead to a severe economic recession. Previous recessions have exacerbated levels of child poverty with long-lasting consequences for children's health, wellbeing, and learning outcomes.10" End of Quote.
The authors are pointing out futuristic negative outcomes in National interests.
5. Quote "Policy makers, school administrators, and other local officials thus face two challenges. First, the immediate nutrition and learning needs of poor students must continue to be addressed." End of Quote.
Quote "Second, local and national legislators must prepare for the considerable challenges that await when the pandemic subsides."
It may best in the Nation's interest to set up a National Level Task Force to address this.
Part XX. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Tsinghua University launches School of Public Health" Published: April 11, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30819-9
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Post Publication Independent Review of
Tsinghua University launches School of Public Health
Published: April 11, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30819-9
India has several Central, State, Private, Deemed Universities, Institutions of Eminence, Autonomous & Affiliated Colleges, across a diverse spectrum. It may be the need of the hour to encourage interdisciplinary research on Public Health in every Institution of Higher Education in India. The interdisciplinary nature of research pursuit at every Institution may be related to the existing courses that have been currently approved, so that the departments existing now will also get enriched. Subsequent to the research pursuits yielding substantial research outcome, the same area of research may be translated as interdisciplinary PG or UG courses (as per feasibility), with eminence tag in that area of research to that Institute, with substantial Govt. patronage.
Further, suggested that all current, trainee & prospective Govt. Officials (Central & State) may undergo refresher courses at nearest identified Universities/Colleges on preparation/handling/managing emergencies/pandemics/disasters etc.
Suggested that a related periodic Memorial (Interactive) Lecture Series be instituted at the Union Ministry Level addressed by eminent global experts/researchers/personalities. During the half or one hour period of lecture, suggested that all educational institutions across the Nation suspend regular activity and tune into the lecture via centralized facilities or handheld devices. Moderation of Interaction may be done by a centralized team. Further suggested that all Doordarshan Channels broadcast the same so that it can reach every citizen. To ensure maximum absorption of knowledge conveyed & discussed, the same may be translated into content, specifically blended with relation to the absorption medium, for eg., school level, college level, society or general public, etc.
Suggested that concerned Ministries and the National Disaster Management Authority create an inter-ministerial task force for effective governance.
The following content quoted from the research manuscript reviewed post publication will add better insight.
1. Quote "As the world continues to battle the coronavirus disease 2019 (COVID-19) pandemic, Tsinghua University, one of China's most academically acclaimed higher education institutions, launched its School of Public Health on April 2. The school is aiming to train the next generation of professionals who will take on the responsibility of safeguarding the public health of the world's most populous country." End of Quote.
2. Quote "“The current epidemic has revealed some of the obvious shortcomings in our nation's epidemic emergency response and public health management system”, Qiu Yong, president of Tsinghua University, said during the opening ceremony of the school. “It also reflects the importance and urgency of global collaboration in public health.”" End of Quote.
3. Quote "Compared with other schools of public health in China, which were originally developed in association with schools of medicine, Tsinghua's is expected to operate with other departments, including humanity and social sciences, science, engineering, and management, to create a multidisciplinary curriculum. With a focus on infectious diseases, Tsinghua's School of Public Health will collaborate with departments such as the Department of Earth System Science, which has strong monitoring and modelling capabilities on environment-related diseases—the foundation of big data-based infectious disease modelling and prevention" End of Quote.
4. Quote "Local governments in China have few public health experts to guide their policy-making process, so Tsinghua will include special training to different levels of governors as part of its plan to become a leading power in training public health professionals to address the pressing issues in China's disease control" End of Quote.
5. Quote “We are actively engaging in a dialogue with the government to allow us to build an omniscient surveillance system and systematic modelling capacity”, said Gong, “so that it could gradually achieve the predictive and early warning powers to serve the nation and the world.” End of Quote.
Part XXI. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Virtual health care in the era of COVID-19" Published: April 11, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30818-7
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Post Publication Independent Review of
Virtual health care in the era of COVID-19
Published: April 11, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30818-7
1. Quote "In the face of a surge in cases of coronavirus disease 2019 (COVID-19), physicians and health systems worldwide are racing to adopt virtualised treatment approaches that obviate the need for physical meetings between patients and health providers." End of Quote.
While the industry grapples with the corona virus lockdowns and outbreaks, the authors here are drawing attention to a hitherto much-not-explored vertical, namely, virtualized healthcare.
2. The authors point out two situations, diametrically opposite geographically & demographically
Quote "“I'd estimate that the majority of patient consultations in the United States are now happening virtually”, says Ray Dorsey, director of the Center for Health and Technology at the University of Rochester Medical Center (Rochester, NY, USA). “There has been something like a ten-fold increase in the last couple of weeks. It's as big a transformation as any ever before in the history of US health care." End of Quote.
Quote "In China, patients were advised to seek physicians' help online rather than in person after the pandemic first emerged in Wuhan in December" End of Quote.
3. Quote "China's virtual care transformation was unleashed when the country's national health insurance agency agreed to pay for virtual care consultations because the hospitals and clinics were full" End of Quote
It does require some prompting to overcome barriers whenever a new protocol or process is introduced, and telemedicine also has its own share of acceptance woes.
Suggested that the following articles may be read
Now, that the COVID-19 outbreak has caused a major paradigm shift to telemedicine, it can be expected that both the healthcare service provider and the recipient will be more willing to embrace telemedicine, coz in conventional medical practice, its always the patient who is at the receiving end, and whose clinical conditions may change based on multiple factors, with possible fatality too, while the healthcare provider was at no risk.
The healthcare service conditions have changed rapidly now due to the COVID-19 outbreak, where the healthcare providers' clinical conditions may also possibly change, with fatality not being ruled out.
Consequently, we can expect that both health care providers and receivers will be more cooperative to embrace healthcare, in a better way, than in the past.
When both the healthcare providers and receivers cooperate better with regard to telemedicine, then it certainly opens up more scope for the telemedicine industry as a whole, inclusive of research and academics.
4. Quote "Following China's example, on March 30, at the direction of US President Donald Trump, the Centers for Medicare & Medicaid Services (CMS), which oversees the nation's major public health programmes, issued what it termed “an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic”." End of Quote.
This observation by the authors indicates that Policy Decisions may need to be taken at National Level and immediately percolated thorougly, given the threat due to COVID-19 and also a new direction for the various industries related to telemedicine and healthcare, inclusive of academic and research initiatives.
Read together with https://www.businesstoday.in/current/corporate/coronavirus-maruti-noida-firm-get-up-govt-nod-to-supply-10000-ventilators/story/400080.html, when an automobile manufacturer can turnout ventilators, which were hitherto manufactured only by the healthcare industry, then, it implies that any & all industries can immediately jump into the Telemedicine vertical with minor modifications to their processes, which again needs National Level approvals, regulatory nods and waivers.
5. The following observations by the authors helps provide insights that this is not just an Information Technology Enabled Service, but is an Interdisciplinary Technology Enabled Service, drawing from known realms of Medicine, Engineering, and Sciences, with immense potential in hitherto unexplored realms of Medicine, Engineering & Sciences, which implies that there is a tremendous scope and potential for academia, research and industry to work together. Perhaps, this interdisciplinary Telemedicine was the magic potion that the whole world was looking for, as a stimulus or ground breaker to overcome the lag/stagnation in multiple areas caused due to COVID-19.
Quote " “As we confront [COVID-19], we're racing to implement virtual health-care technologies as quickly as we can. The scale and pace of change is unprecedented for Canadian health care.”" End of Quote.
Quote " “It's inexpensive and expedient, but it'll never be the same as a physical examination with all of its human qualities of judgment and communication. But with COVID, this is a trade-off we have to accept.”" End of Quote
Quote "Trisha Greenhalgh, co-director of the Interdisciplinary Research In Health Sciences Unit at Oxford University (Oxford, UK).
“We have a research project that has been tracking the use of video conferencing in Scotland over the past 6 months, and in the space of the last 2 weeks we've seen [a] 1000% increase in use”, said Greenhalgh. “It's incredible. [COVID-19] has done what we couldn't do until now, because, suddenly, it's not just the patient who might die—now it's the doctor who might die. So the doctors are highly motivated. The risk–benefit ratio for virtual health care has massively shifted and all the red tape has suddenly been cut.”" End of Quote.
Quote "In Italy, although all 20 regions had implemented national telemedicine guidelines as of 2018, hospital managers have been largely caught off guard by the explosion in digital demand, says Elena Sini, information officer for GVM Care & Research, a network of nine private hospitals in northern Italy.
Many Italian hospitals lack the necessary hardware and technical resources, she noted in a March 23 webinar. “Burnout is also a concern for IT staff, so set up some psychological support for IT staff”, she advises.
Sini reported a lack of hardware due to broken supply chains and insufficient bandwidth capacities as the demand increased by about 90% on fixed landlines and 40% on mobile networks in Italy. “We have to ramp up telemedicine capabilities, but for most hospitals in Italy this is an issue. We just don't have the capabilities to deliver.”" End of Quote.
Quote "Speaking alongside Sini, Henning Schneider, chief information officer for Asklepios Kliniken, one of Germany's largest private hospital networks, said the COVID-19 pandemic is highlighting a need for intensified IT collaboration between German hospitals. In New Delhi, India, Anurag Agrawal, director of the Council of Scientific and Industrial Research's Institute of Genomics and Integrative Biology, says Indian health-care providers have become similarly preoccupied with virtual health care while the country is in near-total lockdown. “Suddenly, after years of resistance to virtual health care, our physicians keenly want it”, said Agrawal. “[COVID-19] is breaching the barriers to virtual health care faster than anything in history.”" End of Quote.
6. Quote "the Indian Government is copying China's tactics by releasing a set of newly developed applications that use instant messaging platforms, such as WhatsApp, to enable a suite of virtual health-care services, including public messaging about behavioural modifications, epidemiological tracing, and access to virtual health-care providers. " End of Quote.
Perhaps, due to the nature of the emergency caused by COVID-19, it was acceptable to copy another Nation's strategies, but, to sustain in the long run, INDIA needs its own new challenging strategies in Telemedicine, that extends beyond consultation and remote examination of lab results. Perhaps, like the Aadhaar, it is time that the Indian Govt. gives out a new scientific policy regarding Telemedicine based Healthcare and helps enable infrastructure that will completely digitize all healthcare processes and protocols, lab investigations, etc., with multiple distributed cloud based servers, IOT, AI and related services, so that any citizen can avail healthcare service at any Primary Health Care center based on his integrated healthcard.
Policies, and Regulatory Mechanisms need to be put in place for every aspect of Telemedicine based National Healthcare delivery, so that every Govt. Hospital, Private Hospital, Labs, etc. are part of one Giant Pool of the Telemedicine based National Healthcare System.
Further industrial policies and regulatory mechanisms need to be modified so that existing industrial infrastructure can be used to manfacture a new generation of Hospital, Lab and Communication Equipment, Hardwired & integrated Software & Communication Solutions.
7. It is time to think, modify and adapt all academia, industry and research activities towards an integrated interdisciplinary Telemedicine Based Healthcare System post COVID-19, for the world is never going to be the same again and opportunity always comes only as a blessing in disguise.
Quote "“The regulatory barriers that have held virtual health care back for all these decades were never justifiable”, Jadad avers. “[COVID-19] is an opportunity to blow all these barriers away. And the question now is ‘how far are we willing to go?’”" End of Quote.
8. Read together with
Quote "India has tremendous capacity in eradicating coronavirus pandemic: WHO
The executive director of the World Health Organisation (WHO), Michael Ryan, said India, the world's second most populous country, has a tremendous capacity to deal with the coronavirus outbreak as it has the experience of eradicating the small-pox and polio through targeted public intervention. End of Quote
available at url https://economictimes.indiatimes.com/news/politics-and-nation/india-has-tremendous-capacity-in-eradicating-coronavirus-pandemic-who/articleshow/74788341.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
It can be understood that if INDIA has tremendous capacity in eradicating coronavirus pandemic, then it is a natural consequence of the same statement that INDIA has tremendous capacity in handling the situations that arise post the coronavirus pandemic; and the first situation that will arise is integrated interdisciplinary Telemedicine based Healthcare Delivery (not limited to virtual consultation alone, but inclusive of all healthcare delivery protocols, processes and practices).
Consequently, the responsibility now falls on the Academia & Research to show the pathways to the Industry, and together (Academia, Research & Industry) seek required new approvals, regulatory modifications (to pre-existing facilities), and work together in synchronism to establish the next generation integrated interdisciplinary Telemedicine based Healthcare Delivery.
If an automobile manufacturer can manufacture ventilators and provide them on a warfooting, instead of waiting for the healthcare manufacturers to provide the same, it indicates that all that is necessary is a paradigm shift in our thinking & perpectives and to make best use of existing facilities and upscale wherever necessary.
Since India has several Govt., State, Private and Deemed Universities; Research Institutions and Industry Associations, there can always be an avenue for new multiple thronged approaches for the next generation of interdisciplinary Telemedicine Approaches. Whoever is successful, whether it be Academia or Research or Industry or a combination of the three, an eminence tag can be added to them, and Govt. patronage provided maximum to those with the eminence tag, so that India can give to the World, the next generation of Healthcare Processes, Protocols and Delivery based on interdisciplinary Telemedicine based approaches. These new activities have the potential to enrich the existing academic facilities, with scope for new academic courses, accompanied with pathbreaking research initiatives that translate into optimized existing and new industry infrastructure and output, inclusive of all diverse realms of Academia, Research & Industry.
Part XXII. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Handbook_of_COVID_19_Prevention.pdf "
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Post Publication Independent Review of
available online at https://covid-19.conacyt.mx/jspui/handle/1000/25
Preliminary Examination of the Handbook indicates that it is a 68 page document outlining various protocols and procedures for COVID-19 treatment classified under three sections as
1. Prevention & Control Management
2. Diagnosis & Treatment
Considering the elaborate medical procedures outlined, and the urgent nature of the information conveyed, a trade-off is noted to arise between
a. Reviewing the document & obtaining significant information and insights
b. Saving Precious Lives.
with specific reference to the detail that Google Scholar indicates that this item is available since the past 2 days (while this review was written on April 18, 2020).
The weightage to
b. Saving Precious Lives
a. Reviewing the document & obtaining significant information and insights
and the file is presented as it is below, so that it may save precious lives.
Since there might be network congestion (if the file is downloaded heavily), it has been downloaded and made available with due acknowledgement to the original link and presented below.
The file can be directly accessible via link at https://drive.google.com/open?id=1gB9ZU7F6RO434XfTRU97aVwJPlxhju1k as a pdf file, which has been downloaded from the original website at https://covid-19.conacyt.mx/jspui/handle/1000/25 and made available herewith.
Part XXIII. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "Vlachopoulos, D. (2020). COVID-19: Threat or opportunity for online education?" Higher Learning Research Communication, 10(1), 16–19. DOI: 10.18870/hlrc.v10i1.1179
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Post Publication Independent Review of
Vlachopoulos, D. (2020). COVID-19: Threat or opportunity for online education? Higher Learning Research Communication, 10(1), 16–19. DOI: 10.18870/hlrc.v10i1.1179
1. Quote "The United Nations Educational, Scientific, and Cultural rganization’s director-general, Audrey Azoulay, said in a recent statement (“Coronavirus Update,” 2020), “While temporary school closures as a result of health and other crises are not new, unfortunately, the global scale and speed of the current educational disruption is unparalleled and, if prolonged, could threaten the right to education” (para. 1)." End of Quote.
Quote "To ensure a continuity in students’ learning, even under sometimes fragmented national regulatory frameworks—which make the recognition and accreditation of nontraditional (face-to-face) degrees challenging—some governments are looking to find a solution in online education initiatives. Such initiatives may include the use of online synchronous communication and the design, delivery, and assessment of online learning activities within a virtual learning platform. " End of Quote.
The authors observations enforce our understanding that we have been following the traditional way of education, viz, face-to-face education system in a geographical unit which may be a University or College or any subdivision thereof, but we have been pushed into a non-traditional way of education via online education initiatives. Consequently, there will be some concerns that need attention.
2. Quote "For many online education researchers and practitioners, the COVID-19 crisis is being considered as a unique opportunity to support both students and institutions by filling the gap left by conventional (face-to-face) education. Indeed, online education has a number of advantages, not least that it allows educators and students to continue teaching and learning from any location without interruption. As a result, educational institutions can continue to receive anticipated revenues. " End of Quote.
In a period of lockdown and social distancing due to COVID-19, online education may have its own advantages with reference to continuity of teaching-learning processes and anticipated revenues for educational institutions, it remains to be seen whether the advantages manifest themselves the same, or modify in a post COVID-19 environment.
3. Quote "What educators, students, and institutions involved in these “emergency” online education initiatives should keep in mind is that these new measures are, on the whole, untested, and in some cases, they are not applied consistently across educational institutions. " End of Quote.
This observation by the authors seem to be quite valid and may need sufficient attention too.
For instance, attention is drawn to this article at https://in.pcmag.com/how-to-work-from-home/135851/zoom-vs-microsoft-teams-vs-google-meet-a-videoconferencing-face-off
While this review is being written on 20.04.2020, the MHRD has launched a portal YUKTI (Young India Combating Covid with Knowledge, Technology and Innovation). The following links may be accessed for appreciable details
It is noticed that access is unable to be obtained externally. However, an introductory video on youtube details the features in it.
Quote " Union Human Resource Development Minister Ramesh Pokhriyal ‘Nishank’ said. “The portal will cover both qualitative and quantitative parameters for effective delivery of services to the academic community at large,” he said. “It will also allow various institutions to share their strategies for various challenges which are there because of the unprecedented situation of Covid-19 and other future initiatives. We hope the portal will give inputs for better planning and enable us to monitor effectively our activities for coming six months,” Nishank added. The portal will also establish a two-way communication channel between the ministry and the institutions so that necessary support system can be provided to the institutions. “We are confident that this portal will help in critical issues related to student promotion policies, placements related challenges and physical and mental well-being of students in these challenging times. The web platform will epitomise its name and prove to be a great enabler in taking the research to the ultimate stakeholders, the citizens of our country,” he added." End of Quote.
It is noticed that Central Universities, IITs, IIMs, IISERs, IISc, IITs, MHRD, NITs, Schools of Planning & Architecture, and some Centrally run Schools are listed access.
It is a very appreciable attempt by the MHRD, but at the same time, the challenges that may be faced by a vast majority of Private Institutions may be more acute than those faced by Central Universities and Institutions of repute (discussion of which is beyond the scope of this review).
This brings us back to the quote in this review comment (from the article being reviewed) Quote "What educators, students, and institutions involved in these “emergency” online education initiatives should keep in mind is that these new measures are, on the whole, untested, and in some cases, they are not applied consistently across educational institutions. " End of Quote, for it is going to take some time before consistency can be achieved, in which time challenges are going to be felt persistently.
4. Quote "Given the circumstances, relying on online education as a solution to ensure continuity of learning in areas impacted by COVID-19 may well prove to be overly optimistic. Especially in countries that take a more conservative approach to the recognition and accreditation of online education, the failure of this experiment may lead to the misconception that online learning is ultimately an ineffective learning model. In turn, this may cripple the progress of less traditional ways of teaching and learning. To avoid this eventuality, it is important to highlight some actions that need to take place for the smooth and effective implementation of online education. " End of Quote.
The authors are pointing out a concern that needs to be given attention.
Let us examine it as a hypothetical case.
a. Assuming, that a University or Institution has been providing quality education, fulfilling appreciable regulatory and/or accreditation norms at National and/or International levels.
Under such a condition, the University or Institution will be attempting to render quality service here too, and consequently, will try to make available additional budgetary allowances for provisioning of online facilities for its faculty and students and also upscale its information technology infrastructure, so that it can attempt to sustain the same model, if deemed necessary in the post COVID-19 scenario; or even otherwise, to extend services to any other online program of the University or Institution in future.
Faculty & Students may also be provided support, especially in this time of bandwidth congestion due to work at home, when all corporate high bandwidth lines are lying idle, and all connectivity has to be done via the home/personal internet connection; by staggered online interaction either live or recorded.
Difficulties encountered, limitations, etc. will add to the knowlegebase of the University or Institution and will assist the learning curve, so that in due course of time, the online education module would be able to be operated seamlessly in an efficient manner, yielding acceptable results.
b. Assuming, that a University or Institution has not been providing quality education, appearing to fulfil regulatory or accreditation norms but not in reality.
Under such a condition, the University or Institution will be stressed out, because, all that has been so far hidden, may start to show its reality, which may earn negative public opinion about the University or Institution.
No Individual nor groups of individuals nor institution will immediately attempt corrective measures. Usually corrective measures, may be taken only as a last resort, when there could be no other option, but otherwise, it is never in human practice (apart from notable exceptions), to take corrective measures. Consequently, the first option would be to kill the messenger instead of accepting the message and take corrective measures. Hence, the first attempt may be to discredit the online teaching-learning process. And it works best, if the Students are made to express discrediting remarks about online teaching-learning process. Since marketing divisions usually have a better voice compared to quality control divisions (though exceptions may be there), and if there is an opinion from the Students section discrediting the online teaching-learning process, it is usually treated as lines out a sacred holy book (though exceptions may be there).
So, it can be understood that reactions to the online teaching-learning process may be varied, and the true essence needs to be taken and given due significance.
Now when the above quote from the research article is read again, it does indicate a significant concern, which needs to be addressed. The quote is provided below for the sake of convenience.
Quote "Given the circumstances, relying on online education as a solution to ensure continuity of learning in areas impacted by COVID-19 may well prove to be overly optimistic. Especially in countries that take a more conservative approach to the recognition and accreditation of online education, the failure of this experiment may lead to the misconception that online learning is ultimately an ineffective learning model. In turn, this may cripple the progress of less traditional ways of teaching and learning. To avoid this eventuality, it is important to highlight some actions that need to take place for the smooth and effective implementation of online education. " End of Quote.
Sufficient attention and necessary processes/protocols need to be called for, with greater good for the Nation in mind, instead of serving the vested interests of a few, which can even compromise the National interests globally.
Street-smartness was never an option, while Nobility is quite essential when standing for National Interests or for that of mankind globally.
Attention is hereby called for the Twitter Broadcast by the Prime Minister of India via https://twitter.com/PMOIndia/status/1251839308085915649 , exhibiting the highest orders of Nobility.
Consequently, when any concern of National Interest or for that of mankind globally requires Nobility; then a more higher order of Nobility may be required in Higher Education; and more so, during times of such pandemics as COVID-19, when the right to education itself may be at stake.
Otherwise, such new initiatives such as online teaching learning processes cannot be attempted as a non traditional way of teaching; holding high promise of evolving into a traditiona way of teaching of the future. And whatever needs to be done, to obtain accurate unbiased observations out of such online teaching learning processes, has to be done.
5. Quote "Governments and policymakers should create a framework for each level of education—primary, secondary, and higher—that will equally focus on the implementation of online education, the required methodologies, and the desired outcomes of the practice. " End of Quote
Quote "Although each institution should be given the flexibility in how to implement online learning, a validated framework and some common goals are necessary to ensure consistency, learning, and achievement. " End of Quote.
Once this is done, online learning will become streamlined and will also help to provide more avenue for innovations & enhanced research output at multiple levels; with enhanced transparency which will benefit all stakeholders and the Nation.
6. Quote "According to the United Nation’s (2015) Sustainable Development Goal 4, “achieving inclusive and quality education for all reaffirms the belief that education is one of the most powerful and proven vehicles for sustainable development” (para. 4). Does everyone have access to the necessary hardware and software for online delivery? If not, how can we provide such resources to the most vulnerable groups at short notice? Any meaningful effort to this end must rely to an extent on a collaboration between the government and the private sector. " End of Quote.
Especially when development activities face a lag due to COVID-19, thrust on online education may open up new verticals as a direct or indirect consequence of the result of such activities.
7. Quote "Current research has demonstrated that technology itself doesn’t guarantee an effective—or pleasant—learning experience. This can only be achieved through systematic training initiatives that clearly set out the teaching and learning that institutions expect of their educators and students, respectively. These training initiatives should be in line with the policy frameworks discussed earlier and should cover both technological and pedagogical aspects. End of Quote.
Any new system will always have a learning curve associated with it. Since the traditional systems of University or Collegiate Education are decades/centuries old, we dont have a learning curve; but we do experience a learning curve whenever a new adaptation is brought into the traditional system of education. Consequently, there will definitely be an associated learning curve for online system of education. Since the focus is on online education, the training initiatives themselves can be undertaken at a National Centralized Facility, which will help all Institutions throughout the Nation to receive uniform standardized training, instead of relying on distributed unrelated nonstandardized local facilities to provide such training initiatives. Also, if such training initiatives are done via a National Centralized Facility, it may also possibly root out any type of unhealthy consultancy/lobbying efforts for higher ratings/accreditation of Institutional Online-Teaching Processes.
8. Quote "Online education can undoubtedly offer new learning environments that make learning accessible and support students in developing competencies, skills, and attitudes (Vlachopoulos et al., 2012). Evaluation and monitoring of these new environments should be carried out for many reasons: to identify their impact on students’ learning experience; to provide us with insights into how and what the students are learning; to provide us with data on how online practices can be improved; and, finally, to provide an evidence base that can be used by other countries looking to implement online education." End of Quote.
Due to the impact of COVID-19, every Nation on the Planet will be looking for desperate solutions to innovate and open up new verticals. Under such conditions, where survival of the fittest may not be an exception but a norm, evaluation, monitoring and standardizing such avenues of online education can also possibly lead to enhanced FDI in online global education, wherein the service area is not limited by geographical boundaries. With proper accreditation (devoid of any type of unhealthy consultancies and lobbying) in force, with genuinely verified faculty holding genuine academic degrees issued by genuine academic Institutions, such new online learning environments, apart from providing avenues for growth for the Students, the Institutions and the Nation; these new online learning environments may also help to provide the much needed space for the growth of the Faculty too, which will again translate into better results from these avenues; accompanied with consequent transparent online monitoring & accreditation records that can cause brand elevation by themselves, without any need for further marketing.
9. Quote "There is no doubt that this current context is leading to a reconsideration of investments in educational technology, as investors, education technology companies, governments, officials, and policymakers are trying to support this emergency remote-teaching situation (Hodges et al., 2020). Specifically, we see several education technology companies offering free access for institutions, teachers, and students to some of their products and services, which are now tested by millions of users from all over the world. Moreover, institutions are in negotiations with companies on bigger projects, such as the acquisition of learning platforms, proctored examination solutions, and synchronous communication solutions, among other products and services. It is important to mention that this uptick in demand does not lead to an increase in sales, mainly because most of these institutions don’t have the budget for such initiatives or because they don’t have effective procurement processes. At the same time, governments and officials cannot decide on whether they should invest in short-term solutions or a long-term plan. " End of Quote.
There has been a massive investment in the Education Sector (at School, College & University Levels). Apart from genuine efforts to reap benefits for all stake holders inclusive of Students and the Nation, there could have also been undesirable offshoots (without proper long term planning in conjunction with short term benefits) as profit maximization achieved by exploiting possible loopholes in regulatory norms, unhealthy consultancy/lobbying efforts, nonstandard administrative processes, deceptive student centric processes, etc. with/without the realization of the long term undesirable consequent effect of demotion of brand value, that can possibly obliterate the Institution itself, with possible associated capital loss.
The introduction of online learning processes in the Education System, accompanied with monitoring & accreditation processes, and consequent transparent monitoring & accreditation records, should be able to attract good investments from the Nation and Worldwide, which will help to further enhance the quality of online education systems in a cyclic manner, with a consequent automatic purging of malaise that could have crept into the Education Systems. Further, it is expected to obliterate any & all (known & unknown) unhealthy practices that could have been possibly plaguing the Education Systems.
A Systematic Approach at the National Level, will sure lead to very good results in the Education Sector, consequent direct development in the Education Systems, with collateral benefit to Research & Industry.
In summary, Online Education Systems which are Nationally Monitored, Accredited and Transparently Governed may be the magic potion that that the Nation could be looking for, to cope up with the uncertainties in the post COVID-19 world, whether it be Academia, Research or Industry and consequently revamp the Economy, with consequent collateral benefits in Foreign Policy & better Relations.
Part XXIV. A faint beam of light at the end of the tunnel.... Post Publication Independent Review of "The self and its world: a neuro-ecological and temporo-spatial account of existential fear" Clinical Neuropsychiatry (2020) 17, 2, 46-58
Twitter Communication Link:
Publons Review Link:
Post Publication Independent Review of
The self and its world: a neuro-ecological and temporo-spatial account of existential fear
Andrea Scalabrini, Clara Mucci, Lorenzo Lucherini Angeletti, Georg Northof
Clinical Neuropsychiatry (2020) 17, 2, 46-58
1. This article was seen and flagged for later review. Attention is drawn to the news item at link https://www.indiatoday.in/india/story/maharashtra-man-dies-after-being-attacked-on-suspicion-of-being-covid-19-patient-1670415-2020-04-24
This news item prompted immediate review for this research article "The self and its world: a neuro-ecological and temporo-spatial account of existential fear" and hence review is initiated on 24.04.2020.
2. Quote "What is happening nowadays with the pandemic spread of COVID-19 is an existential threat for us as individual selves related with others, both belonging to a shared world. Our sense of self and others is threatened by the danger of i) being infected, ii) infecting other people, and (iii) the loss of social relation. This abnormal situation has an impact on us as subjectivities being intrinsically related with others and the world, leading to different neuronal and psychological responses on the basis of our basic emotional feelings, as is the case of fear." End of Quote.
We need to understand and appreciate that the fear (if any) that we experience about the COVID-19 or coronavirus outbreak is a neuronal or psychological response to our basic emotional feeling of fear, that has been triggered due to an acute threat perception to our life due to COVID-19 outbreak.
There are two aspects that need to be given significance here.
i. The Threat Perception Level.
ii. The Body's immune response to any infection/disease.
The threat perception even if it is high due to the severity of the COVID-19, can be brought down if the candidate can understand that their Body's immune response to infection/disease can be improved.
When the threat perception is brought down, then the fear factor subsides and consequently, all damaging effects due to the fear factor also subside.
The key to this rests in certain phenomena/concepts/principles similar to those outlined at https://health.clevelandclinic.org/how-mindfulness-training-can-help-you-achieve-immunologic-health/
Consequently, either this concept or any related concept can be used to improve the Body's immune response to any infection/disease. Once the candidate is affirmed that his/her Body's immune response is good or has improved, then the threat perception due to COVID-19 starts getting lowered by the candidate. Once the threat perception starts to get lower, the candidate starts getting confident that he/she wont succumb to the COVID-19 infection, which will consequently bring down the fear level, and immediately stop all damaging after effects to the self and to others. A more beneficial effect of this and further subsequent processes is that the candidate will approach the handling of the COVID-19 in a more practical and pragmatic way.
a. The Prime Minister of INDIA Shri Narendra Modi was right when he requested all the Citizens to light candles or a lamp at a prefixed time for a prefixed duration as reported at https://www.indiatoday.in/india/story/pm-narendra-modi-on-coronavirus-lockdown-1662747-2020-04-03 . People cooperated, though some questioned the efficacy of it.
b. Further, The Prime Minister of INDIA Shri Narendra Modi, again suggested to the people to perform yoga during lockdown period to reduce stress as reported at https://www.ndtv.com/india-news/coronavirus-pm-narendra-modi-shares-video-of-yoga-asan-to-help-relieve-stress-during-lockdown-2203394 Again people would have cooperated, done as suggested and benefitted by it, but at the same time there were also some who questioned the efficacy of it.
This research article (reviewed here) was accepted on April 05, 2020 and available shortly via Google Scholar, and a review could have been done, but
i. it might have been perceived as singing praises of the novel approaches of the Govt., and hence it was not done.
ii. it was flagged for later review, and more important concerns were taken up for review; insights and further suggestions were shared
c. Also, there was a twitter broadcast on April 19, 2020 by the PMO on behalf of The Prime Minister of INDIA Shri Narendra Modi at https://twitter.com/PMOIndia/status/1251839308085915649 (cause of which is beyond the scope of this review, but the good scientific effect of which falls within the scope of this review). An acknowledgement was filed (though we were not the intended recipients of the aforesaid tweet broadcast by the PMO) at https://twitter.com/PrabhuBritto/status/1251875783498321920 and again flagged for later reaction.
However, the recent trend as cited above via news item https://www.indiatoday.in/india/story/maharashtra-man-dies-after-being-attacked-on-suspicion-of-being-covid-19-patient-1670415-2020-04-24 has forced this review to be done now.
Another reason why this research article was flagged for later review was that, the suggestions of the Prime Minister of India to the Nation as indicated in Review Comment 2a and 2b had a scientific basis and the broadcast by the PMO also had a scientific basis, which did not receive sufficient concentration. Further, when handling a pandemic of such proportions, when scientific concentration is provided for every concern, it should not become another topic of discussion in the Media with possible diversion of focus from pressing issues on hand to sensitive issues.
Significantly, the scientific explanations was available as a set of research articles published in open access (S. No. 26 to 53 at https://www.prabhubritto.org/research-contribution-as-international-journal-publications-papers ), and ofcourse, priorities of the people could be different and not many might have attached value to those research articles because any research article gets its due attention only when the discussions or findings of those research article are essentially needed, though the discussions and findings may have a perpetual value. And if we took any effort to help reach the findings of those research articles, at this time, it may amount to
i. Singing praises of the Prime Minister of India Shri Narendra Modi
ii. Marketing/Propagating ourselves in times of crisis (COVID-19)
Consequently, we were following the developments, providing post publication reviews and suggestions on many other areas, deemed necessary at those points of time.
The Scientific Explanations of the hitherto scientifically unexplained phenomena relating to three seemingly unrelated actions & suggestions of the Prime Minister of INDIA Shri Narendra Modi (Review Comments 2a, 2b and 2c) can be had at S. No. 26 to 53 at https://www.prabhubritto.org/research-contribution-as-international-journal-publications-papers. Further, if any further details are required on ways to improve the Body's immune response and to further understand more advanced concepts, the interested reader can refer to S. No. 26 to 53 at https://www.prabhubritto.org/research-contribution-as-international-journal-publications-papers . Since that research was done in stages and hence reported, some extent of similarity among papers might be there, so that any reader can have a continuous flow of thought in the paper being read and may not need to refer multiple previous research articles over multiple citations at every stage of report. Consequently, the interested reader is suggested to read from S. No. 53 in descending order, towards S. No. 26. Discussion of these articles here will broaden the scope of this review a lot, and hence discussion is not done here. However, the interested reader can refer to those articles in ways suggested herewith.
However, it can be seen that the scientific discussions in the aforesaid research articles bears a direct relation to the actions of the Prime Minister of INDIA Shri Narendra Modi, providing a solid scientific background to his seemingly unrelated suggestions (Review Comment 2a, 2b, 2c) in this time of COVID-19 outbreak.
We had flagged for later review (if required), as we had to maintain our Scientific Integrity and do not indulge in any action that can be misunderstood as praising the Prime Minister in times of crisis (COVID-19).
We are now writing and filing this review due to news item https://www.indiatoday.in/india/story/maharashtra-man-dies-after-being-attacked-on-suspicion-of-being-covid-19-patient-1670415-2020-04-24, as if we hesitate to review now and file it, our Scientific Integrity may be questioned from a different perspective, if we choose to remain silent spectators when we should have shared the knowledge vested with us.
Reading again the above comments, we understand that we have the solution with us (for COVID-19), and we also appreciate that we are going in the right direction in handing COVID-19, and there is no need for any anxiety or fear and there is no need to damage the life of anyone else (suspected of being a COVID-19 patient) to protect the self; we can now proceed to the further sections of this review which will help us understand the phenomena better and we can also handle ourselves better too; and also prepare ourselves and future generations on overcoming any large scale pandemic with the knowledge that we can derive further.
3. Quote "In humans higher levels of fear destroys the sense of security in the world producing higher level of stress and anxiety. In these extreme cases the world is not perceived as a “secure base”. The FEAR/Anxiety System can be activated by various external events as well as by internal ones. These are usually triggered by specific external events that have been paired with pain or other threatening stimuli, but feelings of fear can also emerge simply from the internal dynamics of the brain, what has been called free-floating anxieties." End of Quote.
In simple words, whenever any individual or group of individuals start feeling that the ground is slipping beneath their feet (while in reality, the ground may not be slipping at all), their stress and anxiety levels start rising up in indirect proportion to the fall in their belief/faith system. This is where the action taken/suggested in Review Comments 2a, 2b and 2c will help to strengthen the belief/faith system in the individual, giving them a collective impression of a support system by the Govt., in addition to their belief/faith system.
4. Quote "The FEAR/Anxiety System can be activated by various external events as well as by internal ones. These are usually triggered by specific external events that have been paired with pain or other threatening stimuli, but feelings of fear can also emerge simply from the internal dynamics of the brain, what has been called free-floating anxieties. Indeed, when humans are stimulated intensely, primary-process FEAR circuits motivate to freeze and flee in apparent frights. In these conditions people report being engulfed by intense anxiety and fear (e.g. “scared to death”) with no necessary environmental cause (Nashold, Wilson, & Slaughter, 1969)" End of Quote.
Now, in this COVID-19 outbreak period, there could be many external events that can cause anxiety.
Consequently, The Prime Minister of India was offered some humble suggestions that would help him and his govt. handle the COVID-19 outbreak more effectively. Some action was taken, which was also promptly acknowledged and thanked. Details are available at https://drive.google.com/open?id=1gBCZnKoj7BY0R_EnkIxl0WPQzKIey7vL
It was observed that this time of lockdown was also attempted by many to raise their ratings or brand value. There is a time for everything. But this is certainly not the time to raise ratings or elevate brand value. This is the time when the whole Nation has to stand together with the Govt. (and the Govt. stand with the People) and together undertake tasks that are essential to contain the pandemic spread and save maximum lives. However, it was also observed that for selfish interests, the people's anxiety was attempted to be kindled and many a time, observed that the COVID-19 containment process faced a difficult path, even forcing the Prime Minister to appear on Television and issue an apology magnanimously (as a damage control exercise, coz that was not the time to point fingers and aggravate any concern). Profiteering, Business Interests, Ratings, and other concerns of the self may need to be pursued, but this is not the time when the self needs to be promoted at the cost of so many lakhs and crores of lives at stake.
Hence, knowingly or unknowingly, the anxiety level of the society may have risen due to unscrupulous actions of some or many. This has caused life threatening stimuli to be released, throwing out of sync, the restoration mechanisms of the brain against free-floating anxieties that can rupture the internal dynamics of the brain. Consequently, many could have become prisoner of their own uncontrolled thought processes, with heightened anxiety and fear, scared to death that they have caused the death of a person who coughed (https://www.indiatoday.in/india/story/maharashtra-man-dies-after-being-attacked-on-suspicion-of-being-covid-19-patient-1670415-2020-04-24 )
5. Quote "Fear and anxiety can then be seen as strategies of the brain to re-balance and ultimately ‘normalize’ its intero- and extero-ceptive input – the brain establishes relationship to the body, which is manifest in fear/anxiety. More deeply, it tells us that even an emotion as basic as fear is not isolated and locked-up in the brain or the organism. Instead, the data tell us that fear is intrinsically relational, something constituted neuro-vegetatively as based on the interoceptive input from the body. That, in turn, establishes relationship to the environment and the world – taken in a more general sense, emotions like fear/anxiety are thus about the balance between world, body, and brain and are thus genuinely relational and neuro-ecological." End of Quote.
In simple words, fear & anxiety which were hitherto treated as personal traits, were and are never a personal trait, but was only a relational reaction of the brain and the body to the society, and more intricately related to the influencers, otherwise called as the Media & Public Speakers. The Media and the Public Speakers have to appreciate and respect their role during such pandemic containment and help the common man understand what he/she needs to understand, and should never raise the anxiety levels of the common man for any type of business or political or individual benefits. There is a time to care for the self, and there is a time to care for the society, and during a pandemic containment time like now (due to COVID-19), it is never the time to care for the self or selfish reasons, but to care for the society genuinely. These times should not be seen as an opportunity to make hay while the sun shines. Irresponsible action during these times may raise the fear and anxiety levels drastically in people, and consequently that may vent out as undesirable happenings which could affect the life of many (Ofcourse, these statements are recorded here with the understanding that not many will care and may pursue their own selfish interests only, but we have to do our duty with integrity, and hence we do our duty, against all odds).
6. Quote "it is possible to understand how the current international pandemic crisis situation due to COVID-19 has a strong impact on our fear/anxiety levels. Just as the virus’ global spread accelerated, the perception and the attention towards our inner state have increased sharply. So while externally, media and social networks are gathering attention over the threatened worldwide situation, internally, we experience increased interoceptive awareness, in an attempt to early detect the symptoms of the virus. The prospect of being infected or of being able to infect our loved significant others makes us experience the constant state of worry lived daily by those suffering from an anxiety disorder. The more these possibilities become concrete, i.e., by becoming aware of virus-positive friends and acquaintances, the more our own self-integrity and its relationship with the world are threatened which, in turn, induces anxiety/fear." End of Quote.
These observations by the authors adds more credence to Review Comments above.
7. Quote "On the deepest level of our existence, we are intrinsically connected with the other – we constitute our self through our intrinsic connection with the other. That very same intrinsic connection to the other shapes our self through what psychology describes as attachment. The data show that early life events like traumatic childhood events in our relation with others strongly shape our self, leading to malfunctioning attachment and major changes or deficits in the structure of self." End of Quote.
Now, we can understand that we do have attachments at multiple levels, for instance, family, friendships, relatives, neighbours, caste, creed, community, religion, language, politics, movie actors/actresses, and the list is endless. The trauma associated with COVID-19 is something that no living person has seen, coz its been so many decades ago that pandemics of this scale have been witnessed, and not many who have seen such pandemics decades ago may be alive now.
These attachments cause major vulnerabilities of the self, and the damage to the self and the society can be on a very large scale, if fear and anxiety levels are elevated by any one or more of the attachments. At this point, the action of the attachments (in raising the fear or anxiety levels) can be done by the attachments knowingly or unknowingly. It may not be possible to restrain all attachments, coz every attachment cannot be expected to exhibit nobility and the benefit to the self may also be an agenda of the attachment. Consequently, when the attachment raises the level of fear or anxiety in the individual, not only is he/she going to suffer but he/she may also become a cause for the society suffering, which is already taking a very big hit due to the COVID-19 outbreak.
8. Quote "The threat of the coronavirus presents us with a double threat – collapse of our subjectivity as due to the risk of our body being infected and collapse of our inter-subjectivity as by social isolation of our self from others. The double threat of both subjectivity and inter-subjectivity provides a depth dimension to our emotions including our fears and anxieties resulting in existential fear. Such intimate connection of fear, self, and existence, is due to the way our brain and its spontaneous activity are organized, that is, it stabilizes itself by aligning to body and world in very much the same way we stabilize our movements during dancing by aligning to the rhythm of the music. That very same alignment of our brain to body and world, i.e., temporospatial alignment is threatened if not disrupted by the corona virus crisis – in the same, one dances erratically when being detached from the music’s rhythms, we become existentially threatened and erratic when the brain’s and ultimately our self’s temporo-spatial neuroecological alignment to the world are threatened by both the virus and the defense measures of physical and social distancing. Nowadays reading life on the basis of daily confrontation with the death and connected existential fears is at the same time the threat and the value of this time. Loss of subjectivity is manifest in our loss of body and thus the fear of dying, while the loss of intersubjectivity surfaces in our fear of infecting others and thereby losing a key component of our relation and alignment to the world, that is, ultimately, the others and thereby our self. In those instances, one would wish that our brain would operate differently. However, that is a hope doomed to fail as we, through our existential fears, pay the price for the virtues of our brain as it lets us experience our own self in synchrony with and being aligned to others and the wider world. "
Now, let us read the review comments from Comment 1 again. It will help us to understand better.
Consequently, we have only one solution. We will have to follow the Prime Minister of INDIA Shri Narendra Modi with reference to his twitter broadcast at https://twitter.com/PMOIndia/status/1251839308085915649 with the following message Quote "COVID-19 does not see race, religion, colour, caste, creed, language or borders before striking. Our response and conduct thereafter should attach primacy to unity and brotherhood. We are in this together: PM @narendramodi" End of Quote.
Hence, we will have to be modest, shed aside our egos, let pride take a backseat, respect the knowledge of those whom we have never respected so far (for their knowledge never brought in tonnes of Gold or Cash or Stocks or Precious Jewels) for their knowledge could only lives and make life better, and bring them to the forefront in this National & International fight against COVID-19 if we really want to save lives.
If our motive was never to save lives, but only hold on to the chair, the power and the prestige associated with the chair, we can continue however we like to continue.
If our motive is to save lives, we need to bring all those knowledgeable people who need to be brought in, irrespective of caste, creed, community, color, language, race, religion and handle the COVID-19 containment & treatment processes for the good of all.
We can choose whether we want to go down in history as a divided nation that destroyed itself coz of ego, race, religion, caste, creed, language etc. or whether we want to go down in history as an ancient civilization that lived up to its roots that were thousands of years old, and showed a pathway of life, for all life on the planet and for all Nations of the World.
Now it can be understood why the review of this research article was flagged for a later date, for we knew what was the reason and we also knew what was the solution.
When we now understand that societal damage to life has started to happen, it would be wrong on our part to delay the review. Hence the review was started to be written on April 24, 2020 and finisht on April 25, 2020 and filed appropriately by twitter and by email to the Prime Minister & the Govt. of INDIA. Since this set of reviews has already been shared to the world, it is understood that the whole world can share the insights of this review, and utilize it to save lives globally.
Part XXIX. Post Publication Independent Review of “Alternative scenarios for the impact of the COVID-19 pandemic on economic activity in the euro area”
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