What are ICMR testing results

ICMR was earlier conducting tests only on suspected patients, i.e., those who had travelled abroad, those who had come in contact with them and were symptomatic. Only 3% of them tested positive for coronavirus.

ICMR then started a sentinel surveillance program from 15 February to 19 March at over 50 major hospitals in India. Representative samples were collected from all cases of Severe Acute Respiratory Infection (SARI), like pneumonia. In this study, 2 out of 965 samples tested positive for COVID-19.

On 20 March, the testing criteria was modified and all SARI cases across India started being tested. A total of 4,946 samples were tested, of which 102 were positive for COVID-19. So, out of 5,911 cases tested in total, only 104 have tested positive. Despite the fact that testing is targeted, only 1.8% have tested positive.

According to the study, 38% of coronavirus cases do not have a history of foreign travel.

Private labs have only tested suspected cases till now. Among 16,000 tests that private labs have conducted, only 320 have tested positive for COVID-19.

The ICMR stated that a total of 1,79,374 samples from 1,64,773 individuals have been tested in India as on April 11 9 p.m., and 7,703 of them have tested positive.

The virus, not politics, will set the terms

We have three options: Continue staying at home until there is a vaccine, which could take over a year; open the floodgates of activity and face a repeat surge of cases; or prepare and expand our public health capacity so that we can gradually lift restrictions and safely loosen the tap of activity. [NY Times]

The CDC reports that cloth face coverings should:

Include multiple layers of fabric.

Allow for breathing without restriction.

Fit snugly but comfortably against the side of the face.

Be secured with ties or ear loops.

Be able to be laundered and machine dried without damage or change to shape.

Cloth face coverings prepared from household items or made at home from common materials at low cost can be used.

Cloth coverings should not be placed on young children below 2 years of age, those who have trouble breathing, or are unconscious, incapacitated or otherwise unable to remove the mask without assistance.

The recommended cloth face coverings are not surgical masks or N-95 respirators. Surgical masks and respirators are in short supply and are reserved for medical first responders.

The CDC recommendation does not replace, but complements, the social distancing efforts.

It is important to continue washing our hands regularly, cover our coughs, stay at home whenever possible and maintain 6-feet social distancing in order to slow the spread of COVID-19. [CDC]

What is the dose of Ivermectin

12 mg single tablet

Can two people in the same family behave differently with COVID-19

A physician couple, both having COVID-19 infection, responded differently. While one ended up in intensive care, the other was asymptomatic. A lot still remains to be learned about COVID-19, stated Noopur Raje, MD, professor of medicine at Harvard Medical School and director of the Center for Multiple Myeloma at Massachusetts General Hospital (MGH) in Boston.

Raje stated that she wants clinicians to know how symptoms can evolve both quickly and suddenly. She mentioned how for 10 days, she cared for her COVID-19-positive husband at home, separated from him by a floor in their Boston townhouse and wearing a surgical mask and gloves to bring him food and fluids, as he was too weak to help himself.

Despite the high fevers, chills, extreme fatigue, and dramatic weight loss, Raje stated that she felt reasonably confident that her husband was getting better. His temperature had dropped from around 103 to 101, his heart rate was in the 80s, and his blood pressure was "OK," she mentioned. But then Jag Singh, MD, an otherwise healthy 55-year-old Harvard professor and cardiologist, started to cough, and things took a turn suddenly. The cough sounded chesty, and he was weak and unwell. They decided on getting medical help. "I was planning on driving him to the hospital, but I ended up having to call 911, although we literally live across the street," she said. Singh was admitted straight to the medical intensive care unit (MICU) while his wife waited at home. [Medscape]

Look for Red Flag

Raje wants physicians to warn their self-isolating patients and caregivers to look for red flags. "There are primary care physicians who reached out to me and said when someone calls me and says its been 5-7 days and I am still not feeling well, I am going to look at that more seriously.

What is a State lockdown

The Constitution states that subjects of law and order and public health lie with state governments. This means that states can take steps related to the two. The Epidemic Diseases Act of 1897, which has been invoked by several states to order a lockdown, authorizes them to prescribe temporary regulations to prevent the outbreak and spread of a disease.

What is a Centre’s lockdown

The central government had cited a possible "lack of uniformity in the measures adopted (by states) as well as in their implementation" as a reason for ordering a nationwide lockdown on March 24. The lockdown was ordered through the National Disaster Management Authority (NDMA), which is headed by the prime minister, under section 6(2)(i) of the Disaster Management Act, 2005. The Union home ministry, in compliance with the NDMAs order, issued orders for the 21-day lockdown under Section 10(2)(l) of the DMA. [TOI]

Which has more powers - state or central

Article 254 of the Constitution says that if there is an inconsistency between a law made by Parliament and those made by states, the Central law prevails. [TOI]

Can the President intervene

The President has emergency powers to make states and center work together.

Can the states say no the central lock down

No. States can announce their own lockdowns but can’t object to a lockdown mandated by the Centre.

Lockdown extended till 3 May in hindi

What is Xenophobia

From the Greek xenos, meaning "stranger" or "foreigner", and phobos, meaning "fear" is the fear or hatred of that which is perceived to be foreign or strange. It is being seen more and more during this COVID-19 era.

Can Crohn’s disease increase the risk of COVID-19

Having IBD does not seem to heighten the risk of SARS-CoV-2 infection or the development of COVID-19.How long does the virus stay in CT scan center

Equipment used to scan patients can be contaminated with the COVID-19 virus for up to nine days if the machines arent cleaned adequately.

The virus can potentially stay active on metal, glass, or plastic surfaces. According to recent research from the University Medicine Greifswald and Ruhr University Bochum in Germany, the ideal way to decontaminate these areas is by using a solution of 62% to 72% ethanol, 0.5% hydrogen peroxide, or 0.1% sodium hypochlorite within one minute of possible contamination. The findings have been published in the Journal of Hospital Infection (JHI). [Source: Diagnostic Imaging]

How to clean the equipment

After every contact with potential coronavirus patients, it is important to disinfect all CT and MR machine gantries, noninvasive ultrasound probes, blood pressure cuffs, and mouse and keyboards at imaging stations. The surfaces should be washed with soap or decontaminated with the help of low- or intermediate-level disinfectants. Imaging professionals should contact the vendors to ascertain which solutions are best for each machine. [Radiology Business]

CMAAO CORONA FACTS and MYTH BUSTER 48

Can one refuse to treat a COVID-19 patient

MCI Ethics Regulation India

2.1 Obligations to the Sick 2.1.1 Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However, for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.

To be read with

5.2 Public and Community Health: Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs, a physician should not abandon his duty for fear of contracting the disease himself.

Read together with WMA Geneva ethics (below); a doctor is bound to look after his health first, tackle emergencies and refer the non-emergent care.

Can a Physician refuse to treat a patient from any cult community

No. MCI declaration 4 “I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.”

Can a doctor refuse to treat any other doctor with COVID symptoms

MCI ethics: 4.1 Dependence of Physicians on each other: A physician should consider it as a pleasure and privilege to render gratuitous service to all physicians and their immediate family dependants

What is World Medical Association Declaration of Geneva

The Physician’s Pledge

• Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968and the 35th World Medical Assembly, Venice, Italy, October 1983and the 46th WMA General Assembly, Stockholm, Sweden, September 1994and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006and the WMA General Assembly, Chicago, United States, October 2017

AS A MEMBER OF THE MEDICAL PROFESSION:

• I SOLEMNLY PLEDGE to dedicate my life to the service of humanity.
• THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration.
• I WILL RESPECT the autonomy and dignity of my patient.
• I WILL MAINTAIN the utmost respect for human life.
• I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient.
• I WILL RESPECT the secrets that are confided in me, even after the patient has died.
• I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice.
• I WILL FOSTER the honour and noble traditions of the medical profession.
• I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due.
• I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare.
• I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard.
• I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat.
• I MAKE THESE PROMISES solemnly, freely, and upon my honour.

 [https://www.wma.net/policies-post/wma-declaration-of-geneva/]

Does the declaration of Geneva talks about doctor’s health

Yes. “I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard”

Should doctors provide emergency care without any ifs and buts

Up to the 1994 version of the WMA Declaration of Geneva doctors promised to provide emergency care, without any ifs or buts. However, that promise is not repeated in the current version of the document, so that approach doesn’t address the question at hand.

Is it not unethical on the part of government for not anticipating the needs of acute respiratory care

Democratically elected governments have left hospitals unprepared for the current onslaught of patients, not only in terms of ICU beds and ventilators, but also in terms of PPE.

If the scarcity of PPE for frontline healthcare professionals would have been due to a natural occurrence, one could still say that doctors should be prepared to accept a certain higher degree of risk; however, under current circumstances, the lack of protective equipment is by humans (government and the private sector) as a cost-cutting design.

There is no reason why doctors and nurses should risk their well-being, because the government has deprived them of the necessary resources to do their job safely.

Is it ethical to create awareness about COVID-19

MCI ethics: 7.11 A physician should not contribute to the lay press articles and give interviews regarding diseases and treatments which may have the effect of advertising himself or soliciting practices; but is open to write to the lay press under his own name on matters of public health, hygienic living or to deliver public lectures, give talks on the radio/TV/internet chat for the same purpose and send announcement of the same to lay press.

What are the legal implications of COVID-19 in India

Sec 188 IPC:* Violation of order promulgated by Govt.

*Cognizable, Bailable.*

Sec.269 IPC*

Negligently doing any act known to be likely to spread infection of any disease dangerous to life

Imprisonment for 6 months or fine, or both.

*Cognizable, Bailable*

Sec 270 IPC*

Malignantly doing any act known to be likely to spread infection of any disease dangerous to life

Imprisonment for 2 years, or fine, or both

*Cognizable, Bailable*

Sec.271 IPC*

Knowingly disobeying any quarantine rule:

Imprisonment for 6 months, or fine, or both *Non-cognizable.

What is Force majeure

Vis major (Latin) – meaning "superior force", also known as cas fortuit (French) or casus fortuitus (Latin) "chance occurrence, unavoidable accident", is a common clause in contracts that essentially frees both parties from liability or obligation when an extraordinary event or circumstance beyond the control of the parties, such as a war, strike, riot, crime, epidemic or an event described by the legal term act of God (hurricane, flood, earthquake, volcanic eruption, etc.), prevents one or both parties from fulfilling their obligations under the contract.

LIC: the clause of ‘Force Majeure’ will not apply in case of COVID-19 death claims.

Under Indian law, one of the first decisions to deal with the concept of force majeure was the Madras High Court decision in Edmund Bendit And Anr. vs Edgar Raphael Prudhomme. In this case, the Court cited with approval the passage from Matsoukis v. Priestman and Co, wherein the definition given by an eminent Belgian lawyer of force majeure as meaning "causes you cannot prevent and for which you are not responsible", was adopted.

Under both Indian and English law, force majeure does not simply refer to anything outside the control of the parties to a contract. Its meaning, and applicability, is guided by the particular contract, and the particular wording used. It is contractual language intended to anticipate unforeseen events and provide for what happens on their occurrence [Chitty on contracts, Volume I, (31st Edition), Sweet & Maxwell].

What is Section 56 in The Indian Contract Act, 1872

56. Agreement to do impossible act.—An agreement to do an act impossible in itself is void. —" Contract to do act afterwards becoming impossible or unlawful.—A contract to do an act which, after the contract is made, becomes impossible, or, by reason of some event which the promisor could not prevent, unlawful, becomes void when the act becomes impossible or unlawful”.

Leave entitlement in COVID-19 era

Under the Indian law, there is no legal requirement to grant leave for COVID-19 patients exceeding what is statutorily mandated or contractually agreed upon.

Considering that the disease is communicable, it may be advisable for the employers to allow affected employees to proceed on paid leave.

Can you terminate the services of a person who is COVID-19-positive

It is advisable that the employers do not terminate any employee on the ground of he/she being a COVID-19 patient or suspected patient.

What is entry into workplace rule

An employer has a legal right and an obligation to prevent an employee suffering from communicable diseases like COVID-19 from entering the workplace for the protection of other employees.

What is the duty of the employer

Provide specific equipment such as hand sanitizers and face masks.

A checklist for reopening full healthcare

1. Crisis management: review existing policies and ensure that key employees and management are familiar with them.
2. Employment issues: it is the employers’ duty to ensure that reasonable care is taken to safeguard the health and safety of employees at work.
3. Healthcare services continuity: Businesses in the health may be particularly affected by a lack of patients and staff considering widespread quarantine arrangements.
4. Dispute resolution and prevention of violence: Any epidemic will have cases of sudden expected deaths, resource limitation and delay in attending emergencies.
5. Consider carefully commercial contract terms, including force majeure and notice requirements
6. Communication is key: clear communications is needed with key stakeholders as to the impact of the spread of coronavirus on the healthcare business. Investors, customers, suppliers, vendors, and staff need to be informed about how the business is dealing with the issue and what it means for them.
7. Booking appointments and digital payment gateways as early as possible.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA