Thursday, 9 April 2020

Learning to breathe again: The long road to recovery from Covid-19

From muscle wastage to PTSD, patients discharged from critical care face tough convalescence

For Covid-19 patients who respond successfully to intensive care treatment and are able to be discharged from hospital, the road to recovery can still be a lengthy one.

The latest report into patients admitted into critical care for coronavirus so far in England, Wales and Northern Ireland showed that of 2,249 patients for whom data was available, only 344 (15%) had been discharged alive. A similar number had died (346 patients), while the majority – the remaining 1,559 – were still in critical care.
Little is known about what the recovery process looks like, but what is clear is that it will take time, even after leaving hospital. Photograph: mediaphotos/Getty Images
As it is early days in the spread of the virus, the figures from the intensive care national audit and research centre (IANARC) do not paint a complete picture. Additionally, little is known about what the recovery process looks like, but what is clear is that it will take time, even after leaving hospital.

Faiz Ilyas, 24, from Clayton near Bradford, was discharged from Bradford Royal Infirmary last week after eight days, including five in the hospital’s intensive care unit (ICU). He was not on a ventilator (the most intensive treatment) but told the Guardian: “When I get up and go to the bathroom or go to the garden, especially when I have a shower, I get really breathless afterwards. The doctors gave me exercises to utilise the whole of my lungs. They didn’t give me any timeframe [for getting better].”

It is a general rule that the sicker you are, the longer it will take to recover. As such, Covid-19 patients who have been on a ventilator will face the toughest convalescence.

The first step for those patients will be for their doctors to decide they can be taken off sedation and they will then try to get them breathing through the machine themselves. Only when the patient is able to do this will the clinicians remove the breathing tube, enabling the patients to speak, which in some cases – depending on how long they have been intubated – will be the first time in a while.

The ICNARC figures show that of those who have required ventilation in the UK so far, only a third (127 out of 388) have survived.

Among all Covid-19 patients for whom a critical care outcome (either discharged alive or died) has been recorded, 68% of those aged 70 or over died, compared with 46% of those aged 50 to 69 and 24% of patients aged 16 to 49. Men were also more likely to die than women, 52.2% compared with 44.6%.

Additionally, of those who were obese, 57.6% died compared with 45.8% who were overweight and 43.6% who were not overweight. While the findings are not conclusive, these risk factors are confirmed by data from other countries.

Even after coming off the ventilator, the patient will still need assistance getting enough oxygen and this is likely to be through a mask or, possibly, a continuous positive airway pressure ventilator (Cpap), which sits somewhere between a mask and ventilator on the intensity scale.

The patient will stay on the ICU until they are safe to move to a ward – one intensive care doctor told the Guardian this would probably take one to three days after coming off ventilation – where reduced intervention is needed.

But even then the struggle is still far from over. Dr David Hepburn, an intensive care consultant at the Royal Gwent hospital in Newport, wrote on Twitter: “If you end up on ITU [intensive therapy unit] it’s a life-changing experience. It carries a huge cost even if you do get better. As our patients wake up, they are so weak they can’t sit unaided, many can’t lift their arms off the bed due to profound weakness. They need to be taught to walk again, breathe again, and have problems with speech and swallowing.”

At the bare minimum, to leave the ICU, sedation will have to have worn off and their breathing must have improved to the necessary threshold. Once they are transferred on to a ward, where they are likely to spend a week or so, being able to breathe without oxygen assistance is a prerequisite for being discharged from hospital.
A Covid-19 patient uses a tablet to speak to a relative who is unable to visit, in Milan, Italy. Photograph: Flavio Lo Scalzo/Reuters

Work will also begin in hospital on remedying the rapid weight loss and resultant weakness the patient will have suffered through muscle wastage as the body went into crisis mode during ventilation. In the first week after ventilation even sitting up in a chair can be a major first step, but as movement increases the muscles improve and get stronger day by day.

When the patient leaves hospital they will still be restricted for weeks to months in terms of exercise, due to both the damage to their lungs and their muscles. This will be the same for patients such as Ilyas, who have not been on a ventilator but instead on a Cpap or high flow nasal oxygen therapy, but their recovery time will be shorter; Ilyas said he can already feel his breathing improving on a daily basis.

Wide ranging psychological problems, from depression to PTSD (post-traumatic stress disorder) are also associated with time spent in an ICU. Patients can also suffer from hallucinations coming out of sedation, which can cause problems such as flashbacks at a later date.

“They get better in time but it may take a year and needs an army of physiotherapy, speech and language, psychology and nursing staff to facilitate this,” said Hepburn. “The few weeks on a ventilator are a small footnote in the whole process.”

(Source: The Guardian)

Sex workers hit by coronavirus lockdown, face hunger and work issues

The 21-day lockdown by Prime Minister Narendra Modi to fight the pandemic has put everyone under the fear of uncertainty. While all of us are trying to figure out our lives under the lockdown, there are certain sections of the society that are worst hit by this epidemic such as sex workers. The lockdown has escalated the risk of poverty and ill health for the sex workers, as there are no clients in the market. Isn’t that the responsibility of government to protect these vulnerable people amidst the lockdown who are struggling for their daily bread?

Add to hunger other finger pointing. There’s loathing and societal shame right now with people in their areas calling them names or being a potential source for disease.

No food, no money
Many sex workers don’t even have the money to afford food since the nationwide lockdown was announced on March 24. Around 80 brothels house close to 3000 sex workers in multi-storeyed dingy buildings located in the busy market area of GB Road, remained shutdown. Since the savings of these workers are meagre there is no other source to finance their daily expenses.

An India Today report noted that people are stuck in these dirty corridors and authorities are strictly monitoring us.

“We cannot even go down to buy groceries or medicines. Many of us are sick but now we have no means to even reach a doctor or call for help, let alone wearing masks. The police do not really listen to us. We anyway have little money left. We do not know when this lockdown will get over. I wonder if all of us will survive this,” said the work.

Lack of support from government
Till now there are no relief packages being exclusively announced for the sex workers. However some NGO and police personnel have voluntarily came forward to help them by ensuring proper food packets, masks and sanitizers. But this is not enough. The sex workers need urgent help from the government, so there is a kind of sustenance available for them.

Making this worse for sex workers is that community support from social impact organisations is also suffering. Rashmi Tiwari of Aahan Foundation wrote a powerful piece on SheThePeople saying “all the positive effects of such programs on the participants and ultimate recipients are slowly withering away.”

Uncertain future
“While many professions seeing a gradual decline in business, sex workers are witnessing a sharper fall. With almost no source of revenue, it is difficult to safeguard their children who are now at home all the time due to shutdown. These women cannot even benefit from the benevolence of the general public who are coming forward to lend a helping hand to other women,” notes Rashmi.

The sex workers are worried about the length of this lockdown and the impact on their business. Even after the lockdown ends and business resumes, there will be all sort of apprehensions among the clients, they worry. The business will take some time to regain its momentum which is another fear among the workers.

Various NGOs and people have been working continuously to support sex workers in different ways. Such as Aanchal Narang who raised money to help the sex workers of Kamathipura, Maharashtra amidst COVID-19 lockdown. She is out on the mission to help these workers, as their daily earnings have taken a hit due to dearth of customers. She also did a project work,named ‘Community Mental Health’ , with the sex workers and closely interacted with them to raise awareness regarding mental well being. Narang runs a put practice in Andheri West as a psychologist with a specialization in addiction,trauma,gender and sexuality.

Sangama, an NGO in Bengaluru is also working towards the rights and welfare of sexual minorities since 1999, has extended a helping hand to make the lockdown period a little easier for sex workers. 

Sangama will provide groceries to 350 families of sex workers. Each kit have suffice consumption for April and May and is worth Rs 2000. The NGO pooled the donations from various people and then using the money for the betterment of the sex workers. 


(Source: SheThePeople.TV)

Coronavirus: Paris bans daytime outdoor exercise

Authorities in Paris have banned exercise outside during the day, as deaths from coronavirus continue to rise in France daily.

The new rules are in force between 10:00 and 19:00 local time, and come into effect on Wednesday.

The death toll in France has risen above 10,000 - the fourth-highest figure after Italy, Spain and the US.

The toll in French hospitals - not counting care homes - was 607 for the past 24 hours, health officials said.

The total now is 10,328, a rise of 16% compared with the Monday total. However, the latest data for care homes is not complete.
Paris residents face further restrictions on exercise. Getty Images

Paris mayor Anne Hidalgo and the chief of police said the new jogging rules would make people exercise "when the streets are generally at their quietest".

  • Italy, with the world's highest death toll, registered 604 coronavirus deaths in the past 24 hours. So its downward trend is continuing - the figure on Monday was 636. The total has now reached 17,127
  • Spain, the second worst-hit country, saw a rise in deaths for the first time in five days on Tuesday - 743, compared to 637 in the previous 24 hours. That pushed the total to 13,798, but the percentage daily increase is about half the level that Spain had a week ago

The Paris daytime jogging ban followed a sunny weekend marked by large groups of people running and walking in the city's parks, despite police controls that include fines for violating the lockdown.

On Tuesday, French Health Minister Olivier Véran said the outbreak had yet to reach its peak, telling broadcaster BFMTV, "We are still in a worsening phase of the epidemic."

France has been under strict lockdown measures for almost a month. Anyone who goes outside is required to carry a document stating their reason for leaving home: shopping for necessities, visiting a doctor, or exercise within 1km (half a mile) of their address.

Police have fined hundreds of thousands of people for breaking the tight restrictions.

There have been positive signs that the outbreak may be slowing. Monday's figures from the French health ministry showed only a small rise of people who need intensive care treatment.

But there have also been concerns about the situation in French care homes. Until recently, reported deaths from the virus only included those who died in hospitals, and not elsewhere.

Mr Véran on Monday announced there would be a "vast operation" nationwide to screen nursing homes, their residents and their careworkers, in a bid to tackle the crisis there.


(Source: BBC)

There was a time ‘fake news’ was used to target ‘Hindus’ for spreading diseases

Racist and communal poison, backed by a section of the media and intelligentsia, has long been a staple of politics.

In these days of COVID-19, I am spending a lot of time catching up on history and it is clear that there are deep connections between the evils of our present times and what happened in days gone by. Whenever there is a clash between truth and belief, there is politics of the worst kind.

In his paper, ‘The historical perspective of Americans of Asian Indian origin 1790-1997’,  Srirajasekhar Bobby Koritala charts the course of Indian immigration to the United States – how the migrants found their feet and the hostility they faced on foreign lands because of outlandish beliefs about them. He lists two categories of people: ‘Great Americans’ who helped Indians in the US, and a ‘Rogues’ Gallery’, where, amongst others, he places Theodore Roosevelt – “racist, imperialist, colonialist, Anti-Asian, anti -Indian’. It is fortunate that despite the former US president’s official standing as a “historically respectable personality,” no one in the US has so far sought to dub Koritala an anti-national.
Source: The Sunday Puget Sound, Bellingham, WA, September 16, 1906.

From trade to labour
In the benign days before they became victims of racism, hundreds of Indians whose main occupation was trade travelled to the US in the 1880s and became so well known that plays like ‘The Rajahs Daughter’ and ‘Cataract of the Ganges’ were staged and there was a popular song titled ‘The Hindu Girl’.

However, things began to change a few years later when larger numbers of Indians, mostly Sikh farmers who migrated from Punjab on account of the unfair practices of the British colonial government, settled along the West Coast of North America, from California to Canada. Most of them worked in lumber mills in British Columbia and  Washington, and on the railroads. They started to do particularly well on the farms in the Sacramento region of California, but they aroused suspicion and were described as ‘treacherous’, ‘filthy’, the ‘least desirable race’, ‘unsanitary’ and carriers of deadly diseases. Evidently, their physical appearance, social customs and religion were not acceptable to the residents who were distrustful of anything not familiar and akin to their own.

Sarah Isabel Wallace in her book, Not Fit to Stay: Public Health Panics and South Asian Exclusion, notes that “while racism and fear of labour competition were at the heart of” exclusionary policies,  “public leaders – including physicians, union leaders, civil servants, journalists, and politicians – latched on to … unsubstantiated public health concerns”  to justify the exclusion of South Asians. She writes that this process began when a story broke in the Blaine Review in the fall of 1907 that the newly arrived South Asians working in the mills were responsible for a meningitis outbreak the previous spring. A Methodist bishop, James Mills Thoburn, who had lived in India for 30 years and had recently returned, said, “Hindoo immigration to the coast was responsible for a great deal of the plague, cere bro spinal meningitis and other disease that have been sweeping the country; South Asians were leaving India in the hopes of escaping the plague, the germs of which they carry with them.”

What Thoburn said was in the category of ‘fake news’, since it was not based on any scientific study, but it appealed to the US public who were in any case opposed to the migrants.

Sikhs, typically addressed as ‘Hindus’, with their traditional long hair, turbans and beards were particularly unacceptable. And then there was the perceived threat of losing jobs as this ‘pauper labour’ was evidently crushing them. Interestingly, US officials had no idea about the religions of India, and it is said that a copy of Koran was put into service in courts for ‘Hindus’ to swear on.

Slowly, anti-Asian hysteria started to build up in Canada and along the US Pacific coast. In 1905, racist Americans formed the Japanese and Korean Exclusion League and in 1907 a Canadian ‘Asia Exclusion League’ (AEL), appeared.

In 1906, Mary Wilson, living in Vancouver, wrote a letter to a local newspaper saying:  “We do not propose to have a Hindu town or bazaar rather, with its vicious evils and attendant undesirable element… We shall have the plague, cholera and other deadly fevers and diseases here among us, if such is not stopped in time.”


Antagonism towards Indians enchanted the press as negativity usually does. In a 1906 headline, the Puget Sound American asked its willing readers, “Have we a dusky peril?”, adding, in case the meaning was not clear: “Hindu hordes invading the state”. A reader wrote, “I consider their (Hindus) advent in this country very undesirable … their code of morals is bad (from our point of view) and if allowed the freedom, which they naturally expect in America, they will eventually become troublesome.”

‘Have We a Dusky Peril?’. Feature article in The Sunday Puget Sound, Bellingham, WA, September 16, 1906.
In a May 1907 article for the Pacific Monthly magazine titled ‘The Hindu Invasion; A New Immigration Problem’, Fred Lockley, a leading American journalist, wrote. “Our kinsmen (Indians) in the far East are turning their faces westward. Here and there a tiny crevice has appeared in the dam that has held them in check for so long. They are trickling through in a slight and apparently insignificant stream into the Western lands but will the stream gradually enlarge till it floods our lands and menaces our institutions?”

Significantly, the US Supreme Court did not initiate a National Population Register at the time. And the United States still does not have one.

But to proceed, the first public meeting of the AEL was held on August 12, 1907, where the MP of Vancouver warned of “an invasion of Asiatics who are swarming into our country every month” and ‘the inevitable result of this great influx of the yellow race will be the retreat of the white race already here”.

The next day, the Vancouver World newspaper headlined a story on its front page – ‘All Parties Opposed to Asiatics’ – and in its editorial wrongly reported that “with the arrival of 160 Hindus on the steamer Athenian and with 2,000 Japanese reported to be on the Indiana which sailed from Honolulu to Vancouver last Tuesday, it is evident that the invasion of Asiatics to British Columbia continues.” In today’s terms, this claim was fake news for the Indiana only had 275 Japanese but the newspaper never apologized.
‘The Hindu Invasion’. Pacific Monthly, 1907.

Anti-Indian riots
To encourage people to plod on, it is often said that Rome was not built in a day. Similarly, riots do not happen in a day. It is only when the mind is completely full of indoctrination and poison that riots happen. Hence what happened in Bellingham in the state of Washington on September 4, 1907, a Sunday when around 500 whites rioted, screaming, ‘Drive out the Hindus’ for about five hours and vandalised their houses and belongings, and took out several men and beat them up, it was not a one off incident. That night, 200 Indians were confined in the City Hall and the rest fled never to return.

But their escape to Everett did not help them and riots happened there on November 5, 1907, following the same pattern and typically the Police just watched. The next day, local newspapers reported that ‘the police were helpless’ and ‘all authority was paralyzed’.

‘Orientals buy arms’. The World (1907)

Not a single person from the mob was prosecuted. I do not intend to make this sound familiar. As I said, the reader’s freedom of deduction I shall honor.

Four days later, September 10, 1907, The World in Vancouver carried a news report, ‘Orientals Buy Arms. Hundreds of Asiatics Purchase Rifles,’ and that sale of weapons was stopped. I must say self- preservation often involves violent means.

Media justifications
After the riots, the Bellingham Herald on September 10, 1907 was of the opinion that, ‘ the Hindu is not of us and can never be……He brings nothing to our country but diseases and filth and a little labor,  in return for which he subtracts some of our capital.’

Though the newspaper condemned the violence, it concluded, ‘the Hindu is not a good citizen’, The Reveille said, “While any good citizen must be opposed to the means employed, the result of the crusade against the Hindus cannot but cause a general and intense satisfaction, and the departure of the Hindus will leave no regrets.”

The Seattle Morning Times argued it was “not a question of race, but of wages; not a question of men, but modes of life; not a matter of nations, but of habits of life… When men who require meat to eat and real beds to sleep in are ousted from their employment to make room for vegetarians who can find the bliss of sleep in some filthy corner, it is rather difficult to say at what limit indignation ceases to be righteous”

Just to be clear, racist or communal organisations with three-letter acronyms like the AEL were not alone in marginalising the Hindus (actually, all Indians). The wider intellectual class was complicit and lent immense legitimacy to these beliefs.

The potency of this vilification may be gauged from the content of tickets in the following format sold for a 1908 event. It says: ‘For your CHILDREN’S SAKE, Vote the Asiatic Exclusion League Ticket… GOOD MEN AND A GOOD CAUSE.’
Children were thus bartered for violence, and violence justified in the name of a good cause.

If this rings a familiar bell, please do not blame me. I am only setting out what history says, on trusting the written word.
To return to where I started, whenever there is a clash between beliefs and truth, politics plays its part. Thus the ‘Asiatic Barred Zone Act’ came to be enacted on February 4, 1917, which effectively meant that persons from barred zones, which included India, could not enter the United States, and thus Indians – and not ‘Hindus’ alone – became blacklisted for the purposes of immigration, on beliefs unsupported by truth.

Let us learn lessons from history. Let us not repeat mistakes, especially when human lives are involved. Let us not play politics with precious human lives.

(Source: The Wire.in)

Wednesday, 8 April 2020

In Vrindavan, a home for widows prepares to protect its elderly from COVID-19

When Usha Dasi, 72, found out about the coronavirus outbreak in the second week of March 2020, she stopped attending puja ceremonies at the Radha Raman temple, 1.5 km from her room at the Maa Sharda Ashram in Uttar Pradesh’s Vrindavan. Breaking with her routine of 15 years, she said she now prays in her room. 

“We have been told that taking precautions, like washing our hands frequently with soap and keeping our faces covered, will keep this disease away,” Usha Dasi told IndiaSpend. The home where she lives has 100 elderly residents. 

Scores of shelter homes dot Vrindavan in Mathura district of Uttar Pradesh, where, for decades, indigent widows have congregated to live and pray--away from families and society that have turned them out, or to seek spiritual solace. There are more than 10,000 such widows in Vrindavan, as per a 2019 report by the NGO Sulabh International, a significantly higher estimate than the previous one of more than 3,000 in 2005, as per a 2009-10 study by the National Commission for Women (NCW). 
Women at the Maa Sharda Ashram put on masks to protect against COVID-19, in Vrindavan, Mathura, on March 22, 2020. Gradually, social distancing norms have also been enforced and adopted. The elderly are more likely to fall seriously ill if they contract the disease. 

Most of these women are elderly--the population most at risk of developing a serious illness from COVID-19. COVID-19 would be particularly dangerous if it spreads in an enclosed space where people live in close proximity, such as prisons and orphanages, the World Health Organization has warned

The pandemic has claimed 62 lives and infected at least 2547 in India (as of April 3, 2020 5:30 p.m.). 

Maa Sharda Ashram is prepared for this situation, said its caretaker, Rajvir Singh. They have a team of 15, including doctors on-call, a 24-hour ambulance, regular medical check-ups and sessions to make the women aware of the need to frequently wash their hands with soap and wear masks.

Maa Sharda Ashram is maintained by Sulabh International. Vrindavan also has six state-run homes for widows, with about 650 residents, said Santosh Mishra, who is in-charge of these homes. 

Widows living here get 20 kg of wheat and 15 kg rice every month, said Mishra. The government’s Indira Gandhi National Widow Pension Scheme provides a pension of Rs 300 per month to below-poverty-line widowed women aged above 40. Those 80 years and older receive Rs 500 a month. The government, in its financial package to alleviate the economic distress caused by the lockdown and to curtail the spread of the disease, has said it would provide Rs 1,000 over a period of three months to widowed women. 

All ashrams have stock in abundance and there will be no problem in providing cereal, soap, sanitiser, medicine and masks, Mishra added. 

The elderly need special care
It is important to keep Vridavan’s elderly widows in isolation or home quarantine and make sure they eat nutritious food, said Ved Prakash, a senior doctor with King George Medical University in Lucknow. 

“Precautions are especially necessary in Vrindavan, as it is a hotspot for tourists, and people from abroad flock the temple city, especially in summers,” he said. 

Before the countrywide lockdown that began March 25, 2020, the district administration and government hospitals had formed several teams that conducted health check-ups and held awareness camps in hotels, hospitals, temples and other places where groups gather, Mathura’s chief medical officer, Sher Singh, and the district magistrate, Sarvagyaram Mishra, told IndiaSpend. Streets were sanitised, and people were asked to wear masks.  

Inside the homes, they watch the news on TV and keep themselves updated on the dangers of the disease, Mishra, the district magistrate said. There are weekly check-ups and the residents have been provided with soap and sanitiser, and entry of people from outside is banned, he added. 

When this reporter visited on March 22, 2020, before the countrywide lockdown, he was asked to first wash his hands with soap, then provided a sanitiser and asked to wear a mask at all times and communicate with the residents from a distance. 

No temple visits, 24-hour ambulance service
The numerous temples at Vrindavan, holy to Vaishnavite Hindus, are usually teeming with tourists and local worshippers. All religious places are now closed for the public until at least April 15, 2020. 

“We have even asked religious leaders, seers and saints of the city to make an appeal to the public that they do not come to temples or gather in groups,” Singh, the medical officer, told IndiaSpend.

The women at Maa Sharda Ashram and the state-run homes have been asked to not go to the temple or even gather at the home to pray. “Instead they have been asked to pray in their rooms,” said Mishra, who is in-charge of the government homes. 

At Maa Sharda Ashram, there is an ambulance round-the-clock. No one has fallen sick so far, said Govind Gupta, a doctor who conducted medical checks at the home. “We have told them [the residents] about the symptoms of this disease and have asked them to report immediately to the hospital if they experience any.” 
A resident of Maa Sharda Ashram shows another how to wear a mask properly in Vrindavan, Uttar Pradesh, on March 22, 2020.

Unhygienic, dangerous conditions
The World Health Organization has emphasised social distancing and hygiene among the protective measures against COVID19. But Vrindivan’s shelter homes are overcrowded and lack basic infrastructure, as multiple studies have pointed out.

These include the NCW’s 2009-10 study cited above, based on interviews with 216 women living in shelter homes run by the government or NGOs and in rented accommodation. The study had highlighted a lack of adequate physical infrastructure, “mainly running water in bathrooms and toilets” and the unhygienic condition of the toilets in the homes. 

Further, overcrowding in the rooms and dormitories was “leading to unhealthy and unhygienic living conditions”, the study said. At Maa Sharda Ashram, each room housed two or three women, we found.
Despite the spirit being “altruistic”, the condition of these homes is “miserable”, a November 2017 review of multiple studies on widows in Vrindavan by the NCW said.

In 2008, the Environment and Consumer Protection Foundation, a charity, filed a writ petition in the Supreme Court to help the widows of Vrindavan “live with dignity”, by requiring the central and Uttar Pradesh governments “to take all steps to rehabilitate them”.

The COVID19 crisis could provide the fillip for such a move in the longer term. 


(Source: IndiaSpend)