To,

Sh Narendra Modi, Hon’ble Prime Minister of India

This is why, because now we know 

1. That lock down has given us enough prevention guidelines
2. That lock down has made India prepared for the eventuality
3. That by continuing lockdown we will only postpone doubling rate by a few days

4. That lock down must continue in red spots in the country

5. That many patients have insignificant symptoms and both asymptomatic and pre-symptomatic transmission of coronavirus can occur.

6. That while world mortality is 6.90%, that of Asia is 5.7% (11 countries average 0.44; 10 countries average 1.6; 11 countries average 3.9; 3 countries average 9.6 and 3 countries average 41.3); Europe is 131 deaths per million population; North America is 42.88 deaths per million population; USA is 167 deaths per million population.

7. That mortality in India is 0.7 deaths per million population and combined for India, Pakistan, Nepal, Sri Lanka, Bangladesh is 0.58 per million population. 

8. That Asian countries are behaving differently in terms of mortality and citizens living in India, Pakistan, Nepal, Sri Lanka and Bangladesh have the lowest mortality. 

9. That SARS 2 virus behaves differently than SARS 1 virus.  While SARS 1 was more transmissive in later part of illness, SARS 2 spreads early. 

10. That SARS 1 was infective when the infection was in lower respiratory tract, SARS 2 spreads when the infection is in upper respiratory tract

11. That most serious patients do not require ventilators as they have problem in the capillaries and not the lung alveoli

12. That the disease can involve practically every organ of the body

13. That mild cases can be treated with home to hospital strategy

14. That hospitals can spread more than 40% of new cases if PPE are in short supply

15. That RT-PCR test may be negative in 33% of cases and rapid tests are not for the acute diagnosis
16. That we need to follow the strategy that every stranger we meet is coronavirus positive and any unknown surface we touch is coronavirus positive

17. The importance of social distancing and masking

18. The importance of hand hygiene, respiratory hygiene and cough etiquettes

19. The importance of selective elderly lockdown and lockdown of patients with comorbidities

20. That we have to live with COVID-19 as the virus is going to stay

21. Now we know that for the next two years we have to avoid gatherings

22. Now we know that we must start living with simplicity

23. Now we know that medical consultation is possible with telemedicine

24. Now we know violation of Epidemic Diseases Act means jail

25. Now we know that by downloading Arogya Setu app, I can know my risk

26. Now we know that even a slight mistake can make my green zone into red or orange zone and get sealed

27. Now I know that disciplined self-lockdown can reduce pollution and deaths due to typhoid, diarrhea, jaundice, food poisoning and pneumonia

28. Now I know that I need to decontaminate my frequently touched surfaces using 0.1% bleach at least three times a day

29. Now I know that I need to take care of my elderly 

30. Now I know that I can work from home

31. That mortality can be reduced but not to become zero

32. That sudden death occurs in 1% of the symptomatic cases

33. That for every symptomatic case, there may be 50 asymptomatic cases

34. Now we know that 3% of new cases detected will require ventilators after 9 days

35. That 15% of new cases will require oxygen after seven days

36. That 80% of the people can be managed at home

37. That we must restrict the meeting time with strangers to less than 5 minutes

38. That doctors to patient face to side (not face to face time) will be less than 5 minutes

39. That single surgeon patient surgical time will be less than 30 minutes

40. That doctors will work in hospital for seven days and then off for seven days

41. That I must start walking or cycling for shorter distances

42. That I must walk stairs and avoid lifts when possible

43. That I must have fully ventilated areas to stay, work or sleep

44. That I must build my immunity; practice Pranayama when alone and start sleeping in prone position

45. That I must now start wearing masks, shoe covers, and head covers

46. That I must now think of getting impermeable cloths

47. That I may have to prefer spaced fully-ventilated hospital wards over closed AC single rooms 

48. That if I am TB positive, I may be isolated till turned negative

49. That lockdown will be implemented if we all spread the pollution in winter

50. That it’s time to quit smoking as it can spread the virus.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA