A Very Heavy and Weighty 2025 New Year Resolution!

2025 New Year Resolutions

It’s that time of the year when we make New Year’s Resolutions. This year’s number one resolution that tops the chart is healthy diet and weight loss which is being wished by 51% of the people. Next is wishing for wealth which is wished by 21%. Finally comes spending quality time with friends and family which is wished by 14%. This is much lower this year post covid lockdown. Is there any correlation to the obesity trends in India with the New Year’s Resolutions for 2025?

Obesity Trends in India

Body Mass Index (BMI) scale is used to indicate if one is obese or not. The different classifications are as unde for India. Please note that this is not the same for other countries which may vary or are higher:

Normal BMI: 18.0-22.9 kg/m²
Overweight: 23.0-24.9 kg/m²
Obesity: ≥25 kg/m²

The prevalence of obesity has been increasing, with nearly one in four Indians now considered overweight. Approximately 24% of women and 23% of men aged 15-49 are classified as overweight or obese in India. Obesity rates are higher in urban areas (30% of men and 33% of women) compared to rural areas (19% of men and 25% of women).

Dietary Trends in India

The Economic Survey 2023-24 noted unhealthy diets and rising rates of obesity need to be tackled urgently to improve health parameters, in order to reap the gains of the country’s demographic dividend. Citing the Indian Council of Medical Research’s (ICMR) latest dietary guidelines, published in April this year, it notes the fact that 56.4% of the total disease burden in India is due to unhealthy diets. The ICMR report observes that the upsurge in the consumption of highly processed foods, laden with sugars and fat, coupled with reduced physical activity and limited access to diverse foods, exacerbate micronutrient deficiencies and overweight/obesity problems.

Correlating Obesity, Diet and 2025 New Year’s Resolutions

There seems to be a positive correlation between the weight loss and what people wishing to achieve in 2025 with respect to their diet and weight. These are many reasons for this correlation. These could be:

Calling for ill-Health: Obesity leads to chronic inflammation and impact longevity (listen to podcast on longevity https://open.spotify.com/episode/19pvPEE7f5UGgzJyXSlLsS?si=5f06687dfcf64232). Over the years, the body’s organs don’t function as effectively as they should. Damage to the pancreas, for example, leads to diabetes; damage to the heart leads to cardiovascular disease; and damage to the brain leads to dementia. And even if someone loses weight, the damage is not irreversible. (The liver is the only organ that can regenerate itself.) Obesity is also linked to many cancers, musculoskeletal problems, depression and obstructive sleep apnea. Some of the co-morbidities with obesity and overweight people include:
- Chronic Kidney Disease
- Type 2 Diabetes
- Cardiovascular Disease
- PAD (Peripheral Arterial Disease)
- Alzheimer’s
- Heart Failure
- MASH (Fatty Liver Disease)

Sounds very alarming for increasing healthcare costs!

Better Employability: As per the National Health and Family Surveys, obese and over weight people have issues with their employability and their ability to work. This is tied to their overall health and their physical abilities. Hence being fit and normal BMI works in their favour.
Lifestyle, Fashion and Aesthetics: One of the most fundamental drivers of behavior is the desire to look attractive. Sales for personal care and beauty products easily exceed USD 25 billion by 2029, and sales for apparel reach USD 550 billion by 2029. This is a very aspiration segment. (listen to podcast: https://open.spotify.com/episode/36TCAlD1gglGXoWJtDa27o?si=09dd617d77434985). A significant number of Indians are unhappy with their weight and body image. A study involving participants from 65 countries found that Indians have lower body image satisfaction compared to many other nations.

Meeting and Beating the 2025 New Year Resolutions

Like any resolution, the compliance to any New Year Resolution is very low. Coming to managing ones weight reduction, the compliance is even lower. The level of compliance with weight loss programs among Indians varies widely. Several factors influence this, including cultural attitudes towards weight, accessibility to resources, and individual motivation.

Cultural Attitudes: In many parts of India, there is a cultural acceptance of larger body sizes, which can affect motivation to lose weight.
Accessibility to Resources: Access to weight loss programs, gyms, and healthy food options can be limited, especially in rural areas.
Individual Motivation: Personal commitment and motivation play a crucial role. Many individuals start weight loss programs but struggle to maintain long-term adherence due to lifestyle challenges and lack of support.

With such low levels of compliance and issues surrounding it, what has the healthcare industry done to find solutions to the weighty problems?

Healthcare Industry’s Invasive and Non Invasive Solutions to Obesity

There are several invasive and non-invasive solutions to obesity reduction. Here’s a brief overview of both:

Invasive Solutions

Gastric Bypass Surgery: This procedure involves creating a small pouch from the stomach and connecting it directly to the small intestine. This bypasses a large part of the stomach and some of the small intestine, reducing the amount of food you can eat and absorb.
Gastric Sleeve Surgery: Also known as sleeve gastrectomy, this surgery removes a large portion of the stomach, leaving a tube-like structure. This limits the amount of food you can consume.
Adjustable Gastric Banding: A band is placed around the upper part of the stomach to create a small pouch that holds food. The band can be adjusted to control the amount of food intake.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This complex surgery involves removing a portion of the stomach and bypassing a significant part of the small intestine. It reduces the amount of food intake and nutrient absorption

Invasive surgery is expensive and not affordable by many. Also, this has to be followed up with non-invasive and other cosmetic surgery later on.

Non-Invasive Solutions

CoolSculpting: This technique uses controlled cooling to freeze and destroy fat cells. The body then naturally eliminates these dead cells over time.
SculpSure: A laser-based treatment that targets and heats fat cells, causing them to break down and be absorbed by the body.
Kybella: An injectable treatment that destroys fat cells under the chin, improving the appearance of a double chin
Emsculpt: This procedure uses high-intensity focused electromagnetic energy to induce muscle contractions, which can help reduce fat and build muscle.
Lifestyle Modifications: Diet and exercise remain fundamental. Behavioral therapy and support groups can also be effective in managing obesity

Each method has its own benefits and risks, and the best choice depends on individual health conditions, preferences, and goals.

GLP-1 The Magic Pill for Obesity

During 2024, a hype has been created over social media, celebrities both in Bollywood and Hollywood about GLP-1 (glucagon-like peptide-1), the wonder drug and magic pill for weight reduction. For the scientifically advanced beings, brief overview of the mechanism of action of GLP-1 (Glucagon-Like Peptide-1):

Secretion: GLP-1 is secreted by the intestinal L-cells in response to food intake.
Receptor Binding: GLP-1 binds to its receptors located in various organs, including the pancreas, brain, stomach, and heart.
Insulin Secretion: In the pancreas, GLP-1 enhances glucose-dependent insulin secretion.
Glucagon Suppression: It suppresses glucagon release, which helps lower blood glucose levels.
Gastric Emptying: GLP-1 slows gastric emptying, promoting satiety and reducing food intake.
Neuroprotection: It has neuroprotective effects and may improve cognitive function.

For the least scientifically advanced beings, GLP-1 works in reducing the food appetite and the weight of a person by 15-20%. In addition, GLP-1 also works on other co-morbidies such as

Diabetes Management: GLP-1 agonists are medications that help lower blood sugar levels by increasing insulin secretion and decreasing glucagon release. They also slow down gastric emptying, which helps control blood sugar spikes after meals.
Weight Loss: These medications are also effective for weight loss. They work by reducing appetite and increasing feelings of fullness, which can lead to reduced calorie intake and weight loss.
Cardiovascular Benefits: Some GLP-1 agonists have been shown to provide cardiovascular benefits, such as reducing the risk of heart attack and stroke in people with type 2 diabetes.
Potential Kidney Benefits: Emerging research suggests that GLP-1 agonists may also have protective effects on kidney function.
Parkinson, Alzheimer’s and Dementia: Early clinical research is showing effective results in patients with neuro issues with a lower risk of the cognitive issues (such as memory loss) that are often an early sign of dementia.
Addiction Management: This is still very early and GLP-1 is being tested on animals and showing positive results on addiction to alcohol and nicotine.

Statutory Warning:

All drugs have side effects, and the GLP-1s are no exception. The most common ones are gastro-intestinal problems, for example diarrhea. In addition, the drugs cause the loss of lean muscle mass, which is particularly concerning for the elderly. Moreover, newer formulations or the next generation of GLP-1 are also being researched and will circumvent the side effects.

GLP-1 in India

In India, several GLP-1 (glucagon-like peptide-1) receptor agonists are available for the management of diabetes and obesity. Here are some of the notable ones:

Liraglutide: Marketed under the brand name Lirafit™ by Glenmark Pharmaceuticals, this drug is used to improve glycemic control in adults with type 2 diabetes.
Semaglutide: Available as an oral formulation, this drug is marketed by Novo Nordisk India and is used for diabetes management.
Exenatide: Another GLP-1 agonist used for diabetes treatment, though specific brand names in India may vary.

I am also informed that there is a venture working on GLP-1 extracted from plants peptides under development.

As for me, I am wishing that 2025 will bring in more innovation in GLP-1 solutions which are more effective!

Happy New Year 2025!

Deny, Depose, Defend – Assassination of a CEO – Making of A New Suspense Serial?

Celebrity Assassinations Inspired by Books and Literature

The US has several cases of Presidents and celebrities who have been murdered where the assassin was motivated by a written books and literature and that became the inspiration and the motive to kill someone who is well known. Some of them include:

John Lennon’s Assassination: Mark David Chapman, who assassinated John Lennon in 1980, was heavily influenced by J.D. Salinger’s novel The Catcher in the Rye. Chapman was found reading the book at the scene of the crime and later claimed that he identified with the protagonist, Holden Caulfield.
Ronald Reagan’s Assassination Attempt: John Hinckley Jr., who attempted to assassinate President Ronald Reagan in 1981, was obsessed with the movie Taxi Driver and its protagonist, Travis Bickle. The character’s actions in the film were inspired by Arthur Bremer’s diary, which was later published as a book.
The Assassination of Robert F. Kennedy: Sirhan Sirhan, who assassinated Robert F. Kennedy in 1968, was reportedly influenced by the novel The Secret Agent by Joseph Conrad. The book explores themes of political violence and assassination.
The Murder of Rebecca Schaeffer: Robert John Bardo, who murdered actress Rebecca Schaeffer in 1989, was found with a copy of The Catcher in the Rye. This book has been linked to several other high-profile crimes.
The Columbine High School Massacre: Eric Harris and Dylan Klebold, the perpetrators of the Columbine High School massacre in 1999, were influenced by Stephen King’s novel Rage. The book, which King later allowed to go out of print, tells the story of a high school student who takes his class hostage.

Nothing comes to my mind about such killings in India, except those inspired by Religious Scriptures.

How can Written Books and Literature be an Inspiration or Prime Motive to Kill?

There are several studies and scholarly articles that explore the influence of books and other media on real-life crimes and killings and their motives. Here are a few key points from the research:

Media Effects on Violence and Crime: Research has shown that exposure to violent media, including books, can increase aggressive behaviour and attitudes. However, the direct link between media violence and actual violent crime is more complex and less conclusive.
Copycat Crimes: Some studies focus on the phenomenon of copycat crimes, where individuals mimic criminal acts they have read about or seen in media. This includes crimes inspired by books, movies, and even news reports.
Psychological Impact: The psychological impact of media on individuals can vary. Factors such as personal susceptibility, mental health, and environmental influences play significant roles in how media content affects behaviour.
Case Studies: Specific cases, like the ones we discuss here (e.g., John Lennon’s assassination), are often analyzed to understand the motivations behind such crimes and the role media might have played.

The points highlighted above address the complex relationship between media consumption and real-life actions.

A New Novel and A TV Serial in the Making

“Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It” by Jay Feinman is an exposé on the practices of the insurance industry. Feinman, a legal scholar and insurance expert, argues that insurance companies often prioritize profits over policyholders by employing strategies to delay, deny, and defend against claims. Some of the excerpts from his book include:

Systematic Denial of Claims: Feinman explains that the denial of valid claims is not an occasional error but a systematic practice designed to maximize profits. Insurance companies often delay payments, deny claims without proper justification, and force claimants into lengthy litigation processes.
Historical Context: The book provides a historical overview of how these practices developed over time. Feinman traces the evolution of the insurance industry and highlights key changes that have led to the current state of affairs.
Consumer Impact: Feinman shares numerous stories of individuals who have been unfairly denied claims, illustrating the real-world impact of these practices on policyholders. These stories highlight the financial and emotional toll on those affected.
Legal and Policy Recommendations: The book offers practical advice for consumers on how to protect themselves when dealing with insurance companies. Feinman also outlines necessary legal reforms to prevent future abuses and improve the insurance system.
Call to Action: Feinman urges consumers, lawmakers, and regulators to take action against these unfair practices. He emphasizes the need for greater transparency and accountability within the insurance industry.

Overall, “Delay, Deny, Defend” serves as a critical examination of the insurance industry, providing valuable insights and actionable advice for consumers and policymakers alike.

Assassination of the United Healthcare CEO – An Inspired Killing?

On Wednesday 4 December 2024, Brian Thompson, the CEO of United Healthcare, was shot at targeted fatal on a midtown Manhattan sidewalk. This has sent shock waves in the industry in the US. Brian Thompson was not an ex-US President in a Presidential race, but yet he was targeted. Well, Brian managed over USD 250 billion healthcare insurance business of the United Healthcare. Hence, he would be in a Presidential status of a smaller country than the US. It seems that Brian Thompson’s assassination, could have been inspired and linked to a 2010 book titled “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It” by Jay Feinman. Police found shell casings at the crime scene engraved with the words “deny,” “depose,” and “defend,” which closely resemble the themes of Feinman’s book.

This blog is not about the condolences to the dead corporate executive, but the change in the mentality of the killers to attach corporate executives.

Industry Achievements of Assassinated United Healthcare CEO

Brian Thompson had several health insurance industry accomplishments and led several specific initiatives during crises that showcased his strategic and compassionate leadership:

COVID-19 Response: During the COVID-19 pandemic, Thompson spearheaded initiatives to expand telehealth services, ensuring that patients could access healthcare safely from their homes. He also implemented support programs for frontline healthcare workers, providing them with necessary resources and mental health support.
Telehealth Expansion: Recognizing the need for remote healthcare solutions during the pandemic, Thompson accelerated the rollout of telehealth services. This initiative allowed patients to receive medical consultations and care without risking exposure to the virus.
Support for Frontline Workers: Thompson introduced programs to support frontline healthcare workers, including mental health resources and financial assistance. These measures were crucial in helping healthcare professionals cope with the immense pressures of the pandemic.
Regulatory Compliance and Advocacy: Thompson effectively managed regulatory challenges by working closely with policymakers. He advocated for policies that would benefit both the company and its members, ensuring that UnitedHealthcare remained compliant while continuing to innovate.
Cybersecurity Enhancements: In response to increasing cybersecurity threats, Thompson prioritized investments in advanced security technologies. This initiative aimed to protect sensitive patient data and maintain trust with members and stakeholders.
Public Relations Management: Thompson handled public relations crises with transparency and accountability. For example, when faced with criticism over healthcare costs, he addressed concerns openly and implemented solutions to improve member satisfaction.

These initiatives highlight Thompson’s ability to lead effectively during crises, ensuring that UnitedHealthcare could navigate challenges while continuing to provide essential services and support to its members and employees. I had met Brian briefly in Minneapolis in 2016 when he was not the CEO of United Healthcare. He came out to be a compassionate and a visionary. But why would someone want to kill him?

Reforms in the US Healthcare Industry Emerging out of “Delay, Deny, Defend”

Based on the events, the wider question to be asked is what needs to be done that Healthcare Executives are not targeted. Here are some of my thoughts coming out of Jay Feinman book. Let me inform the readers here, that I am no expert on the US Healthcare System. I am replaying some of the points Jay Feinman suggests several key reforms to address the systemic issues within the insurance industry to create a more equitable and transparent insurance system, ensuring that policyholders receive the coverage and support consumers are entitled to:

Enhanced Regulatory Oversight: Feinman advocates for stronger regulatory oversight to ensure that insurance companies adhere to fair practices. This includes stricter enforcement of existing laws and the introduction of new regulations to prevent the delay, denial, and unjust defense of claims.
Transparency Requirements: He calls for greater transparency in the insurance claims process. This would involve clear communication from insurers about the reasons for claim denials and the criteria used to evaluate claims.
Consumer Protection Laws: Feinman suggests the implementation of more robust consumer protection laws to safeguard policyholders. These laws would provide better recourse for consumers who are unfairly denied claims and ensure that they receive timely and fair settlements.
Penalties for Unfair Practices: He recommends imposing significant penalties on insurance companies that engage in unfair practices. This would serve as a deterrent against the systematic denial of valid claims and encourage insurers to act in good faith.
Support for Legal Reforms: Feinman supports legal reforms that make it easier for consumers to challenge unfair claim denials. This includes simplifying the process for filing complaints and pursuing legal action against insurers.
Public Awareness Campaigns: He emphasizes the importance of public awareness campaigns to educate consumers about their rights and the tactics used by insurance companies. This knowledge would empower policyholders to better navigate the claims process and protect themselves against unfair practices.

All I can imagine is that the assassin was denied healthcare that he was entitled to by United Healthcare and he thought it as an extreme step to redeem it with the life of the top honcho of United Healthcare CEO.

We will wait for the investigators and police to apprehend the killer and figure out the real motive. But for the time being, Jay Feinman’s book is now going to be a best seller and material for dramatization into a TV serial or a movie.

I am deeply shocked and my sincere condolences to those who feel the loss of Brian Thompson.

The Pandemic of Eyes

Prologue

I wrote a blog on my issues with Hypermetropia, Myopia and Presbyopia Digital Ophthalmology | Kapil Khandelwal KK. It was around December 2021 and we were getting back to regular work after the Covid vaccinations. On my annual health checkup, my eye correction numbers were reduced for both my eyes for distance and reading glasses. But the eyes were seeing some other things. That’s the start of journey of my cataract.

Blurring of Vision

Over the next one year, I was able to see but there were situations when my eyes would hurt me especially under bright light. By December 2022, the eyes would accept my current spectacles would work on some days and on some days, there would be a hazy vision, dryness in the eyes. My lifestyle took a big dip as I was not able to play sports and do my regular walks. All activities were restricted to indoors. Work-life balance took a huge dip. Also my right eye’s vision was deteriorating faster and I could see better from the left eye. In other words, I would behave like the Mad-Eye Moody of the Harry Potter fame.

The Cataract – The Pandemic of Eyes

Cataract is a medical condition that causes clouding of the lens of the eye, which is typically clear. The cloudiness can cause a decrease in vision and may lead to eventual blindness if left untreated. Symptoms of cataracts include clouded, blurred or dim vision, trouble seeing at night, sensitivity to light and glare, seeing “halos” around lights, frequent changes in eyeglass or contact lens prescription, fading or yellowing of colors, and double vision in one eye. According to the Global Burden of Disease Study 2019, the global burden of cataracts has been increasing over the years, with a rise of 91.2% in disability-adjusted life years (DALYs) from 1990 to 2019. The study also found that globally, age-standardized prevalence and DALYs rates of cataracts peaked in 2017 and 2000, respectively. The prevalence rate of cataracts in 2017 was 1283.53 per 100,000 population, while the DALYs rate was 94.52 per 100,000 population in 2000. The burden of cataracts is expected to decrease by 2050. This may not hold true in the post Covid Era.

Earlier as per WHO, the prevalence of cataracts increases with age, from 3.9% at age 55 to 64 years to around 92.6% at age over 80 years. This epidemiology is fast changing to younger co-horts as per consensus building with the doctors and the intra ocular lenses (IOL) manufacturers. What is this new wave of cataract emerging from?

Sedentary lifestyle during lockdown leading to diabetes, high blood pressure or obesity
Excessive exposure to devices such as mobile, laptops over long working hours during work from home
Some of the experts believe (yet to be proven by longitudinal research) that it is the side effect of the covid vaccine.

But it is certain that cataract is spreading in a much wider age cohort.

Why did I go for Cataract IOL Implant Surgery?

After June 2023, the right eye’s sight started deteriorating faster than usual, despite the eye drops treatment. By early October, various tests recommended a surgical intervention. The surgeon also recommended for the IOL implant to the other eye within a month or two. Times up now. But the issue were:

What are my lifestyle requirements that the IOL implant needs to fulfill?
What type of IOL implant to select?
What make of IOL implant for the type selected?
Are there post-surgical life style modifications to be undertaken?

My Lifestyle Requirements

It is very important for those going in for surgery to decide on what sort of lifestyle modifications you would like to achieve post-surgery. In my case,

Reading: At the outset, I needed to get my eyes vision corrected that will enable me to read books, files on my laptop for 6 to 8 hours a day. I didn’t mind reading with corrective vision via spectacles. Therefore, post-surgery, there will still be a need for reading glasses.
Outdoor sports and activities: Wearing spectacles and playing aggressive sports has always been a handicap for me for years. Therefore, a full correction of my distance sight was very important to me

Types of Intra Ocular Lenses (IOL) to Select From

Depending on the requirements of the condition of the eyes and the vision correction for the lifestyle, there are different types of IOLs available. These include:

There are several types of lenses that can be used to replace the natural lens of the eye during cataract surgery. The most common types of lenses are:

Monofocal lenses: These lenses provide clear vision at a single distance, either near, intermediate, or far. You may need glasses to see clearly at other distances.
Multifocal lenses: These lenses have multiple focal points, allowing you to see clearly at different distances without glasses. However, they may cause some visual disturbances such as halos and glare.
Toric lenses: These lenses are designed to correct astigmatism, which is a common condition that causes blurred vision. They can also correct nearsightedness or farsightedness.
Extended depth-of-focus lenses: These lenses provide a continuous range of vision from near to far, with less visual disturbances than multifocal lenses.

Some of the factors that also need to be also considered are:

Visual needs: The type of IOL you choose will depend on your visual needs. Monofocal lenses are designed to provide the best possible vision at one distance, while multifocal IOLs have corrective zones built into the lens, allowing you to see both near and far objects. Extended depth-of-focus (EDOF) IOLs have only one corrective zone, but this zone is stretched to allow distance and intermediate vision. Accommodative lenses can also correct vision at all distances, using the natural movements of your eye’s muscles to change focus. Toric lenses have extra built-in correction for astigmatism.
Lifestyle: Your lifestyle can also play a role in choosing the right IOL. For example, if you enjoy outdoor activities or sports, you may want to consider an IOL that reduces glare and enhances contrast sensitivity.
Budget: Not all IOL types are covered by insurance, and some can cost more than INR 50,000 out of pocket. Medicare and most insurance companies cover the cost of the most common IOL, the monofocal lens. Multifocal, EDOF, toric, light-adjustable lenses, and accommodative IOLs are considered premium lenses and can reduce the need for glasses or contact lenses.
Health: Your overall health and medical history can also play a role in choosing the right IOL. For example, if you have a history of eye disease or other medical conditions, your ophthalmologist may recommend a specific type of IOL.

Based on the above-mentioned types and factors, I decided to go for monofocal IOLs.

Not all manufacturers make all types of lenses. Moreover, many of these players are leaders in one type of lenses in terms of innovation or have invented specific materials. So which are the key manufacturers that I shortlisted.

Key IOL Manufacturer’s in My Consideration List

For monofocal IOL, my recommendation list is as under:

Johnson & Johnson: Johnson & Johnson Vision is a subsidiary of Johnson & Johnson that specializes in eye health products. They offer a range of IOLs, including the TECNIS Eyhance™ Intraocular Lens.
Alcon: Alcon is a global leader in eye care and offers a range of IOLs, including the AcrySof IQ PanOptix Trifocal IOL.
Hoya Corporation: Hoya Corporation is a Japanese company that specializes in optics and photonics. They offer a range of IOLs, including the iSert Preloaded IOL.
Bausch Health Companies: Bausch Health Companies is a Canadian pharmaceutical company that offers a range of IOLs, including the Crystalens AO.
Carl Zeiss Meditec AG: Carl Zeiss Meditec AG is a German company that specializes in medical technology. They offer a range of IOLs, including the AT LARA Toric.

The key issue here is that not all eye surgeons implant all manufacturers IOLs. Therefore, eye surgeons will recommend the IOLs that they are trained to implant.

Post Operative Eye Sight Recovery

Voila! My distance eyesight was fully corrected. I have no myopia now. But there was residual eye sight correction for reading and near distance such as laptop. My eye surgeon recommended me for a progressive lenses spectacles. Although, progressive lenses are a popular choice for people like me, who need vision correction for both near and far distances. However, there are some drawbacks to consider when choosing progressive lenses:

Adjustment period: It can take some time to get used to progressive lenses. I experienced dizziness while my eyes adjust to the new lenses.
Peripheral distortion: Progressive lenses have a small area of clear vision in the center of the lens, with the prescription gradually changing towards the edges. This has some distortion in my peripheral vision.
Cost: Progressive lenses can be more expensive than traditional bifocal or trifocal lenses. The cheapest lenses are worth INR 15,000.
Limited frame options: Progressive lenses require a specific shape and size of the lens, which can limit your frame options.
Prescription changes: If your prescription changes, you may need to replace your progressive lenses.

It has been 5 weeks since my surgery. However, I am still struggling with my progressive lenses from Titan EyePlus after two rounds of measurement and lenses. I have still 4 weeks of protective eyewear when I step outside. I have started using Polaroid Ultraviolet rays protection sunglasses when outdoors in the sun during the day.

This is my first extended time in front of the screen to work. Coming back to the Pandemic of Eyes. I did see people who were younger than me for cataract surgery waiting in the pro-operative area getting prepped. Look out for more on this issue.

Living in the Age of Disasters: From Multilateral to Bilateral Aid

Introduction

In July 2013, I wrote an article titled The Business of Disasters in my column (w)Health Check ((W)Health Check | Kapil Khandelwal KK). The idea in the article was to encourage the corporate sector in India to innovate business models to manage disasters. (see the text of the article below). The world in the second decade of the twenty first century has witnessed all the types of disasters conceivably possible that has left behind deaths and devastation. A lot has been spoken and written on biological disaster during and post Covid-19 pandemic. The ability to impact these threats is beyond control of the people and more in the hands of the healthcare systems managed by the relevant Governments around the world. We should now discuss on the Geophysical and Hydro-Metrological Disasters where there is still lack of understanding.

The organizational set up and confidence in the multilateral agencies has definitely been dented. What alternatives does the world have now to face the incoming disasters?

Global Maps of Geophysical and Hydro-Metrological Disasters

The global map of Geophysical and Hydro-Metrological Disasters provides that not the regions around the world are at mortality risk of such disasters.

Global Map of Mortality due to Floods and Earthquakes

There are many prediction models available to inform where these disasters will hit next with a fair amount of accuracy. Therefore, unlike biological disasters which are hard to predict before they strike, there is a measure of preparedness that is possible to manage Geophysical and Hydro-Metrological Disasters when they strike. Still the multilateral agencies have not been preparing to meet these eventualities.

Lessons from Recent Disasters

Biological Disaster: Covid 19 Outbreak

During the Covid-19 outbreak, we have witnessed how global multilateral organisations like the World Health Organisation (WHO) were incapable of dealing with the situation that the then US President Donald Trump decided to pull out of the WHO as its major sponsor. Moreover, the manner in which the WHO approved the covid vaccine and its effectiveness is now out. As a result countries like India has to suffer in releasing its vaccine to its own people or supply it globally. Months later release of other countries vaccines, did India supply its more effective vaccine to over 100 countries on bilateral basis. But the delay India faced by WHO for approval of its vaccine lead to flooding of ineffective vaccines.

Geophysical and Hydro-Metrological Disaster

Recently earthquakes and floods which have hit several countries, the multilateral agencies such as International Red Cross were not capable enough to handle the devastation. As a result, many countries have responded to the disaster based on their relations with the devastated country. Turkey earthquake is an example. We still do not know what is going to happen. But major first responders to such countries were on bilateral basis. Here also India responded to Turkey’s request by sending its National Disaster Response Force (NDRF) teams. It’s another issue that Pakistan did not allow Indian aircraft passage through its airspace to reach Turkey faster.

Rise of Bilateralism and Its Risks

Since late 2010s, the financial support received of the member countries to the multilateral countries has been gradually reducing. They have been stretched to maintain their administrative budgets versus funding disaster management operations.

The additional capacity for disaster management which strikes countries in one stroke of nature, lies with other countries in limited measure as multilateral agencies are not adequate enough to handle to situation. These capabilities when aggregated would barely be sufficient to manage the crisis through the disaster. Let’s also understand that bilateral aid and support by other countries is motivated by diplomatic relations and ties. The current Turkey and Syria earthquake demonstrates this vividly. Turkey got the majority of the bilateral aid and support while Syria was not. Another example is the great floods in Pakistan where India’s aid was not requested nor India provided it. Moreover, much of the aid that Pakistanis received was never delivered to the people suffering. This acerbates the plight of the people suffering in these disasters. Therefore geo-political considerations come into play to support disaster management bilaterally. This brings to the point of the risks of rising bilateral flow of disaster management aid, support and services to countries in disaster. Some of these include:

Bilateral aid and support may come with the strings and expectation of support to the doners by the receivers in international politics, trade and commerce at a later stage
The aid and support may not be fairly distributed across the political boundaries which are impacted
Like many aid projects that I have worked in Africa, end abruptly as soon as the crisis is stabilized. The longer-term rehabilitation is not considered in bilateral aid and support. The same may be true in current Turkey-Syria earthquakes.
These incidents also become an opportunity to debt trap the countries which are financially and economically week. Pakistan is a case in point after the floods to Chinese debt-trap.
The checker board of international diplomacy in such circumstances may create more tensions for the donors in the future when other countries compare the situation in their own backyard when it had occurred and who stood up to support them bilaterally.
Political unrest in the donor countries over bilateral support to other countries provided.

Given these risks, would it not be prudent to organize private enterprise business models with innovative financial models to sustain these businesses (see my article below). These were initial thoughts in 2013 by me. But given the frequency of disasters the world and its countries are facing, it become evident that rather than expecting bilateral aid and support, the fully life cycle of disaster management can be managed by private enterprises with full disclosures and accountability. Many ESG and impact funds would definitely invite such ideas of such private enterprises.

Article: The Financials of Disasters

It is time for the corporate sector to take over disaster risk management and disaster medicine in India

Background

Probably the greatest concentration of pilgrims in any region in the world occurs in India’s mountain regions of Himachal Pradesh, Uttaranchal and Uttar Pradesh, where 9.3 million pilgrims each year arrive at the major entry point into the Pahari region. Between 2001 and 2010, the number of visitors to the state rose nearly 200 percent to 30.3 million. Major Hindu shrines located in the state, about 70 percent of the tourists who visit the state visit religious sites. However, last months pilgrim disaster in Uttarakhand with the search and rescue operations for the pilgrims needs to be reviewed. With large-scale politicking, drama and oneupmanship by the political parties in the aftermath of the disaster, requires an assessment on the failure of the government in providing services in such situations and leaves me wondering on the areas where different business models can be operated by the private sector in the health and well being of people in such situations.

1. Sequence of a disaster: “befores”, “durings” and “afters”.

2. Triggering events and coupling causes.

3. Large-scale damage to human life and environment.

4. Large economic costs.

5. Large social costs.

6. HOT (human, organizational and technological) and RIP (regulatory, infrastructural and preparedness) factors.

7. Multiple stakeholder involvement and conflict.

8. Immediate and longer-term responses.

9. Crisis resolution attempts.

10. Focus on symptoms not causes.

What is Disaster and Disaster Medicine?

A disaster is not a “crisis” in the traditional meaning of the word – a situation in which important decisions involving threat and opportunity have to be made in a particularly short time – rather, disasters involve management procedures which must be maintained and management problems coped with under conditions of major technical emergency involving threats of injury and loss of life. (See Box). There are two types of disasters – natural and technological disasters. Natural disasters include three specific groups:

Hydro-meteorological disasters. Including floods and wave surges, storms, droughts and related disasters (extreme temperatures and forest/scrub fires), and landslides and avalanches.
Geophysical disasters. Divided into earthquakes and tsunamis and volcanic eruptions.
Biological disasters. Covering epidemics and insect infestations.

The technological disasters comprise three groups, which are:

Industrial accidents. Such as chemical spills; collapses of industrial infrastructures; explosions; fires, gas leaks; poisoning; radiation.
Transport accidents. By air, rail, road or water means of transport.
Miscellaneous accidents. Collapses of domestic/non-industrial structures; explosions; fires.

The effects of theses disasters can be view on health and well being from five different perspectives. These include:

preparedness and availability of medical and health facilities, services, personnel and equipment;
immediate casualties and deaths caused by the disaster;
secondary illness and deterioration of health conditions following the disaster;
destruction or damage to medical and health centres and services;
response capability of the health services and the capacity for post-disaster recovery.

The response to health problems of such magnitude, under adverse and literally catastrophic conditions, cannot be sufficient with mere emergency medicine or just the provision of relief. Disasters, particularly the one in Uttarakhand are not merely very large accidents; they involve complex public health issues and health management problems at a time when the normal coping mechanisms are disrupted or even out of action. In recent years, the health profession has, to this end, developed new approaches and a new discipline now referred to as “disaster medicine”.

Disaster Medicine is the study and collaborative application of various health specialties – e.g. paediatrics, epidemiology, communicable diseases, nutrition, public health, emergency surgery, military medicine, community care, social medicine, international health – to the prevention, immediate response, humanitarian care and rehabilitation of the health problems arising from disaster, in cooperation with other non-medical disciplines involved in comprehensive disaster management.

In case of floods like that in Uttarakhand the risks of infectious diseases and of malnutrition are real, and the necessary personnel, medicine and supplies should be geared to those needs.

Different Business Models and Opportunities Addressing Disasters in India:

With the occurrence and intensity of disasters increasing in India, there are several business models that we can look as. This is not an exhaustive assessment of the opportunities, but an initial map that can be used to build on to the same.

Pilgrimage Travel/Health Advisory Services

There is no risk rating and advisory services in India that provides travellers with information in the risk rating at different times of the year or on a general travel situation. There are no personalized services that provide information and questions to pilgrims health, security, medical information such as vaccination requirements, infectious diseases common in destinations, food and water safety, and tips on staying healthy while on pilgrimage. Also there are no travel information on emergency medical and other support services. Private weather forecasting and advisory business models do exists. This can be an extension to their business.

Personalised Emergency Medical Care and Evacuation

Membership based services for providing emergency medical care and evacuation is the need of the hour. The services should include evaluation, airlifting, trauma management from the disaster. The services should be followed by consistent protocols with coordination and rapid. One of the areas where a centralized control room which can co-ordinate with the victims and their family members is an essential part of the service. In case of international pilgrims, the service should provide assistance with passport documentation and visa clearances during emergencies, so that the border transits can be smooth.

Specialised Hospitals near the Disaster Zone

With the intensity of disasters increasing in occurrences, there is an opportunity for setting up small specialized hospitals that can cater to the disasters in a specialized way and can be an extension for the supply chain and logistics to the operations in the disaster zone. These hospitals can provide medical equipment, pharmaceuticals, and medical consumables to remote site support.

Medical College in Disaster Medicine in India

There are several institutes of excellence in India that provide courses and degrees in disaster management. However, like the US where there is a board of disaster medicine with special curriculum and licensure of working professionals in this field of medicine, there is no medical college or National Center of Excellence in India providing UG or PG courses. India can well be served by this branch of specializing doctors from a recognized Center of Excellence in Disaster Medicine.

A Public-Private Corporation for Disaster Risk Management

India is one of the countries that consistently ranks amongst the top-5 countries in the world where most of the disasters strike. The lack of faith in the state government of Uttarakhand by the faithful devotees of other states and independent operations by individual state governments to search, rescue and airlift the victims itself gives rise to the business of disaster risk management that could be outsourced to an independent company by these state governments rather than political oneupmnship! On a serious note, other countries that are as disaster prone as India such as Phillipines have used public-private partnerships to disaster risk management using community participation and consistently reduced disaster risks year on year! This will not only create employment opportunities in the community, but also infrastructure and logistics to handle risk mitigation measures on a real time basis.

Some Interesting Business Models in Place

There are some very interesting business models in place for disaster risk management around the world in operation. Some of the ones that need a mention are as under:

Reuters Alertnet:

AlertNet is a free humanitarian news service run by Thomson Reuters Foundation covering crises worldwide. The award-winning website provides news and information on natural disasters, conflicts, refugees, hunger, diseases and climate change.

International SOS:

International SOS is the world’s leading medical and travel security services company. Their enterprise services help organizations protect their people across the globe. Our teams work night and day from more than 700 locations in 76 countries.

Doctors Without Borders

Médecins Sans Frontières (MSF) is an international medical humanitarian organization created by doctors and journalists in France in 1971. Today, MSF provides independent, impartial assistance in more than 60 countries to people whose survival is threatened by violence, neglect, or catastrophe, primarily due to armed conflict, epidemics, malnutrition, exclusion from health care, or natural disasters. MSF provides independent, impartial assistance to those most in need. MSF also reserves the right to speak out to bring attention to neglected crises, challenge inadequacies or abuse of the aid system, and to advocate for improved medical treatments and protocols. In 1999, MSF received the Nobel Peace Prize.

Reflecting Forward

The events that have unfolded in the face of disasters in India require execution and not politicking. It is time private enterprise take over where Government has failed to deliver just like main stream healthcare to the masses, it is time for taking over Disaster Risk Management and Disaster Medicine in India.

A Tale of Two Medical Systems: Revolution Ahead?

Background

The current spat between the Indian Medical Association (IMA) and Baba Ramdev of Patanjali is like a modern version of Charles Dickens’ famous novel A Tale of Two Cities, that led to the French Revolution. The Federation of Resident Doctors’ Association (FORDA) has decided to execute a Black Day on the 1st of June against the controversial statements made by Baba Ramdev against Allopathy and the video shared by him on Twitter. These activities by the allopaths are only goes on to strengthen the value proposition of Alternative Therapies and Indian Traditional Medicine in the minds of the consumer and view IMA and the Allopaths with suspect. The louder the decibel in media the faster would be the Medical Revolution against Allopathy.

Having led the world’s first Integrative Medicine Partnership at the Institute of Ayurveda and Integrative Medicine (IAIM) and served their Advisory Board, I would like to request both sides to set aside their differences and work towards delivering innovative integrative solutions between the two systems for the consumers before it is too late that the consumers bring about a Medical Systems Revolution. Here are some of the points and issues that I would like to lay down for the jury of the consumers to judge and adjudicate.

Investor Perspective: Larger Flow of Investments in Indian Alternative Therapies

Investors and companies invest in opportunities where they see money and value proposition for the consumer’s needs. Let’s understand from the consumers point of view the world over which is becoming more and more skeptic of the allopathic system and their preference towards Indian Traditional Medicine or Alternative Therapies and Medicine for treatment and wellness. Our annual Healthcare and Sciences Heatmap 2021 Investment Heat Map | Kapil Khandelwal (KK) every year is measuring the investment in different sectors including Alternative Therapies. Our conclusion is that Indian Alternative Therapies and Medicine have been gaining wider consumer acceptance and affirmation leading to increased investment activities. Apart from the shift from Allopathy towards Some of the key drivers for investment in this sector are:

Economic growth and rising incomes
Rising per capita expenditures on healthcare products
Low cost of production
Improvements in the distribution network
Increase in accessibility in both urban and rural regions
Awareness programs and subsidies
Rise in non-communicable and chronic diseases

It’s not Baba alone who is the key enemy of the allopaths As per our analysis over 60 corporate groups, pharma and consumer companies, including Multinational Companies (MNCs) have diversified into Indian Alternative Therapies and Medicines with an overall investment of over INR 80000 crores. Moreover, as a boost to this sector, the government recently introduced an economic stimulus package under the Atmanirbhar Bharat and has allotted INR 4,000 crore to the sector for promotion of herbal cultivation. The move aims to cover 10 lakh hectares (24.7 lakh acres) under herbal cultivation over a period of two years

Defamations Cannot Muffle Consumer’s Choice

Nearly 75 per cent of Indian households already use some form of Ayurveda to treat a variety of problems. The writing is on the wall for Allopathy during the current Covid Pandemic, when those who were the forbearers of medical treatment had no answers to treat Covid and the consumers themselves had to search for home made solutions to build immunity and treat mild forms of the infections themselves. Rather than take the prescribed Allopath Doctor’s prescription of artificial vitamins, zinc and tablets, etc. consumers preferred gilroy, kali mirchi, methi, nimbu pani, turmeric, kada, etc. Where was IMA hiding in 2020 with a mass campaign to debunk all these stuff that the consumers were ingesting based on Indian Alternative Therapies and Medicines. I am sure with the current spat between the Baba and IMA allopaths, pharmaceutical companies, doctors and others seem to fear that their dominance is at stake is very apparent.

Indian Alternative Therapies and Medicine are Learning from The Chinese Traditional Medicine

Indian Traditional Medicine and Chinese Traditional Medicine are equally older than Allopathy. However, Chinese export over 5 times more in value their traditional medicines to the world than the Indians. The Chinese were able to lead this sector globally by publishing and sponsoring enough research on quality, effectiveness and safety of their traditional medicine. Moreover they were able to invest aggressively in research in combining their traditional medicine with western medicines into integrative medicine. Why is there no spat between Chinese and the large pharma companies of the West?

India is learning from the Chinese catching up by investing heavily on:

Product innovation is the core to the healthcare solutions that consumers are seeking against allopathic medicine
Study Ayurveda and Alternative Therapies by using the methods and means of western medicine. (As a side note: I know for sure that the same Baba recruited one of my ex-colleagues who was from allopathic drug discovery having worked in US and India to set this up at his Patanjali Research. I am sure he has some aces up his sleeve when he is challenging IMA in the courts rather than just tendering an apology.)
Innovate the basic theory of Indian Alternative Therapies. Different from the western medicine which starts from the molecular biology, Ayurveda is researched and developed based on systematic biology of Kafa, Wada, Pitta. Clinical trials and research is strengthening this potential
Big Data solutions into health informatics to empirically proving where Allopathy stops and Ayurveda starts. At IAIM, there is a large initiative to collect data to prove what limits Allopathy and where Ayurveda benefits the consumer.
Integrating genetics with the systematic biology of Ayurveda leveraging the big data. Apart from the phenotype, genotype and other information is strengthening innovation in the products.

So, my concluding comment on this is spat between Ayurveda and Allopathy is that it’s a lose-lose for both not just in India but internationally giving the Chinese Traditional Medicine a chance to grow its pie internationally. The win-win solution for both the sides is not to prove who is right or wrong on their claims and counter claims and defame both the systems of Medicine in India but to work out an integrative medicine solution between the two. Else we are heading down to the wire on a medical revolution like the Tale of Two Cities dictated by the consumers choice and preferences.

Should We Impose Complete Lockdown Now?

Background

Our Supreme Court has directed the Central and state governments to consider imposing a ban on mass gatherings and super spreader events. “We would seriously urge the Central and State governments to consider imposing a ban on mass gatherings and super spreader events. They may also consider imposing a lockdown to curb the virus in the second wave in the interest of public welfare,” the SC said.

Let us understand that the national lockdown in the first Chinese Wuhan Virus Wave was to create the requisite infrastructure and capacity to ensure that the country does not go into a crisis and the 7-day moving average (7DMA) of infection does not increase the stipulated doubling rate of 1 day. Moreover, the cost of lockdown to the economy for a single day of lockdown is around USD 6.0 billion (INR 45,000 crores approx).

In the second wave, the issues are different. We have our 7DMA of infections is much lower and the doubling rate is much higher. Moreover, as the immunization drive picks up, we will see the two parameters of 7DMA and doubling rate become even more manageable.

So the issue in front of us is, should we impose a complete lockdown and for how long taking cognizance of the Supreme Court directives.

How Far Are We From the Peak in this Second Wave?

In order to arrive at a predictable view of how long should India and its states go into a lockdown and even out the daily economic losses to the country, there are several parameters which we need to consider:

Second Covid Wave in 12 countries before India
Second Covid Wave Peaks in Different States and Cities in India
Covid Immunisation strategy

Second Covid Wave in 12 Countries before India

we can learn from the other countries which have gone through the second wave before India. Based on the learnings from these countries, our Central and State Governments can work out a formula to impose lockdowns and unlockdowns without hurting the economic activity in the country. The table below gives out the duration of the second wave (in days) and % of population that was infected during the Second Wave:

While it is pretty apparent that each country reacted to the second wave differently. The chart below shows how effectively did each of the 12 countries manage the second wave.

Spread of the Second Wave of Chinese Wuhan Virus

Mexico, Turkey, Israel has the second wave duration of less than 100-days, while Germany and Canada had a duration of over 200 days. The peak of the Second Wave was around 120 days (ie 4 months) as an average). The average population that was infected in these 12 countries was around 2.5%.

This is valuable information and analysis for us to predict where India is in the second wave.

Second Covid Wave Peaks in Different States and Cities in India

Maharashtra including Mumbai was the first state to begin with the Second Wave in India. It has already seen the peak and is around the global average of around mid-point of the 120 days wave (ie. 60 days). We will see India as a country peaking by mid-June 2021, unless we solve all the infrastructure and logistical nightmares which some cities like Delhi is undergoing.

WhatsApp Image 2021 05 04 at 08.40.09 — Analysis by IIT Kanpur Prof Manindra Agrawal

The other silverlining is that many other Indian cities are already in their peaks. An interesting analysis by IIT Kanpur Prof Manindra Agrawal shows.

Covid Immunisation Strategy

As I have already written, our Covid immunisation strategy needs to be reworked. It’s not the political compulsions and broad headlines. We need to immunize over 15% of our population by Mid-May 2021 which we have not yet achieved and most likely going to miss the target for the total duration of the second wave and the imposition of nation wide lockdown durations to recede.

Therefore, the opportunity costs for the country in reducing the duration of the lockdown in the second wave is huge provided we implement our covid vaccine immunization strategy and coverage astutely. Invest, invest, invest in immunizations and make it free for all as an incentive. The rest the statistics at the end to the lockdown will reveal.

No Courts in the World Bear the Economic Outcomes of the Country based on their Judgement!

In Search for An End(Demic)

The Coming of End(Demic)?

I have been speaking with cross section of folks over the last few days. Covid Command Center Officials, Health Ministry Officials, Our Doctors, some experts across the world to understand what we are calling the ‘Second-Wave’ of Covid. Many social media posts, new reports are completely confusing the masses now that a few places have now imposed the so called ‘Second-Wave of lockdown to manage the situation. Let me dissect the situation and ally some of the misconceptions and fake news going around. So here are the issues I am hearing

With increased vaccination rate, there is increased covid infection rate
Are the spikes in coronavirus cases due to more coronavirus testing?
There is very high incidence in Maharashtra and Delhi and will spread across the country after the Kumbh Mela
There is shortage of beds, medicines, vaccines to meet the current wave
What should I do?

So is there an End(Demic) in sight to this Covid?

With increased vaccination rate, there is increased covid infection rate

This is totally incorrect. India had administered 111 million doses of vaccine and covered about 7% of the population with one dose. So there is no correlation between vaccination rate and the spike in the Covid Cases in this wave which is due to the following reasons:

A new double mutated strain of SARS CoV2 has been detected in second wave. This is in addition to Brazilian, South African and UK strain. This new mutated virus has the potential to skip the immunity and even vaccine. This is the reason for re-infection cases & cases among vaccinated people.

It is more infectious & affecting younger population of 18 to 45 years group and this group is “super preader”.
By passing RT-PCR – new COVID cases may not be detected by routine RT-PCR test.
R- value is increasing. This is reproductive value which tells one positive person will infect how many others.
Public carelessness & lack of adherence to COVID appropriate behavior (mask, hand sanitization, social distancing & vaccination).
Pandemic Fatigue

Are the spikes in coronavirus cases due to more coronavirus testing?

No. During a surge, the actual number of people getting sick with the coronavirus is increasing. We know this because in addition to people testing Covid positive, the number of symptomatic people, hospitalizations and later, deaths, follows the same pattern. Therefore there is a correlation.

There is very high incidence in Maharashtra and Delhi and will spread across the country after the Kumbh Mela

It is true that Maharashtra has the highest number of Covid positive cases in India at the moment. However other cities and states are quickly catching up with newer cases showing up with a lag effect. The latest map show the spread. (see the map below)

Covid Wave 2 Clusters and Lockdowns and Restrictions Imposed

There is shortage of beds, medicines, vaccines to meet the current wave

Yes there is a lag in the capacity creation and supply with this sudden surge in this wave. Many of the temporary facilities which were lying vacant as the Covid cases went down were utilized for Covid Vaccine Centers. They have now been been used for the treatment and isolation of Covid patients in this wave. On the supply of the injections, many of the manufacturers had now produced these medicines as the demand for them had reduced since October 2020. They are now ramping up production of Remdesivir and this should be available by next week. On the vaccination front, the politics still continues, while a third vaccine from Russia is being given emergency use approval and should also be available by the end of this month.

What Should I do?

Authorities, doctors, clinics and hospitals recognize that more waves are likely to occur. Here’s what you can do now:

Continue to practice COVID-19 precautions, such as physical distancing, hand-washing and mask-wearing.
Stay in touch with local health authorities, who can provide information if COVID-19 cases begin to increase in your city or town.
Make sure your household maintains two weeks’ worth of food, prescription medicines and supplies.
Work with your doctor to ensure that everyone in your household, especially children, is up to date on vaccines, including your Covid Jab

So is there an End(Demic) in sight to this Covid?

So how will these Covid Waves End? Do we see any endemic in sight? Throughout the pandemic, health experts have tended to set the magic number for herd immunity between 50% and 70%. Some of the data coming in shows that

Presumed ‘herd immunity’ is ‘the combined value of infections + vaccinations as % population > 60%

Let me explain the above formula:

Herd immunity is a public health term that refers to the fact that, when enough people in a community have immunity from a disease, the community is protected from outbreaks of that disease. More than 60% of the population needs to be immune to the coronavirus before herd immunity can work. People might be immune from the coronavirus, at least for a while, if they have already had it, but we don’t know this yet. Researchers are currently trying to determine if, and for how long, people are immune from the coronavirus after recovering from Covid. If it turns out that immunity only lasts for a while, people could get Covid again, resulting in even more death and disability. This is the lesson from this wave.

Our country needs to speed up the immunization rate which may take months before we see an end!

Yeh Hai Bombay Meri Jaan, Saab Hain Covid Se Paresaan!

Mumbai Covid Second Wave

Preamble

Earlier in the last decade I was part of the Healthcare Committee of Bombay First which was assisting the Maharashtra Government in the Mumbai Masterplan 2045. One of the key concerns and recommendations made by the Committee was building the healthcare infrastructure for the city, Mumbai lags behind in beds per 1000 population with several key peer Indian cities such as Gurgaon, Delhi, Chennai, Hyderabad and Bangalore. Alongside the shortfalls in hospital beds, there is also a shortage of healthcare professionals, equipment and infrastructure needed at various levels in the healthcare delivery supply chain. The second wave of Covid in the city has once again proved that the healthcare delivery to the Mumbai residents is again in short supply, be it beds, healthcare workers or vaccines. With the crisis looming large, the city is on the brink of a long second lockdown. Without delving into the politics and finger pointing, I want to point out the gaps.

The Gaps in Healthcare Delivery and Covid Response in the City

Hospital Beds Shortage in Skewed Distribution Geographically

In Early 2000s, Mumbai has around as per the Bombay First report, 24,984 beds. As per the recent Mumbai Municipality report, there are 24,039 beds in 2021 in Mumbai. In other words, hospital beds have actually reduced over the last 20 years in Mumbai. It is obvious that many nursing homes have shut down as the doctor/owner have found it lucrative to monetise their nursing homes to commercial real estate. As a result, Mumbai is amongst the worst cities in India with a bed to population ratio of 1.17 beds per 1000 (as against the WHO norm of 3 beds 1000). It was 1.63 beds per 1000 in 2000. Moreover, these beds have been unevenly distributed in Mumbai. South Mumbai has around three-fourths of the total beds in the city which was the case in 2000. This means as the city expands to the suburbs, no additional bed capacity has been augmented in the last 20 years in Mumbai.

**Map highlighting the Geographical Coverage of Prominent Hospitals in Mumbai**

Second Covid Wave in Mumbai and Skew in Spread

As per the recent Mumbai Municipality Report on Covid, the highest increase of positive Covid Cases in the Western and Central Suburbs of the City in the last 7 days. (See the chart below). While the alarming rate of growth of covid positive cases in these wards would take less than 28 days to double the cases. As compared to 35 days as an average for Mumbai city. While the response to Covid is in the Western and Central Suburbs, the concentration of healthcare facilities is predominantly in South Mumbai. While this is leading to a lot to movement of people seeking admissions to hospitals for Covid treatment.

Spread of Covid Positive Cases in Second Wave till 8 April 2021

Action Plan for the Future

The cost of real estate in Mumbai very prohibitive for private healthcare operators to set up greenfield hospitals unless there are regulations to incentivise them. Various recommendations provided by our Committee is not been implemented on the ground. The Covid Pandemic is a wake up call for the City administrators to buckle up and bit the bullet to accelerate healthcare infrastructure in the city by our planners for the future.

The Second Chinese Virus Wave – Trade Off Between Vaccine Strategy and Vaccine Diplomacy

Vaccine Strategy

The Second Chinese Virus Wave – Trade Off Between Vaccine Strategy and Vaccine Diplomacy

There is a second impending Chinese Wuhan Virus Wave in India. Last few days have seen a huge spike in the number of Covid Cases. States like Maharashtra are contributing to over 50% of th cases in the second wave of this pandemic. There are hints of a lockdown while the immunisation drive is now open to second age cohorts of upto 45 years age. Let’s understand, a lockdown is like celebrating an Easter after the economic crusification of the masses when we have proven our vaccines and immunisation drive should be accelerated to cover maximum population which is at risk. Being a student of epidemiology, it begs to reason out the strategy that needs to be followed for immunisation to win over the Chinese Virus in India and sacrifice the wider world’s do good by supplying the vaccines to other countries when our own country is a a peril. In this blog, I discuss on the various options for India.

Where do Indian Covid Vaccines stand in the World Vaccine Race?

India’s CoviShield (rebranded as Vaxzevria on rest of the world) has received the largest purchase orders by the Governments around the world with over one-fourth of the total are going to be supplied by AstraZeneca/Serum Institute. This is on the backdrop of certain adverse event in certain populations of blood clotting. The next in the race are Pfizer/Moderna which has around one-fifth of the commitments. India’s Covaxine from Bharat Biotech is still lagging behind on the 6^th spot.

India’s Vaccine Diplomacy

Although India is the world’s largest vaccine manufacturer, it has won the race against China’s vaccine silk route strategy to dominate the world Covid vaccine supply very early on. From unconfirmed news sources, around 70 million doses have been supplied by India to the world as part of various initiatives to aggressively outwit Chinese Vaccine Silk Route Strategy. India must aggressively meet its commitment for its country and the world to combat the Chinese Wuhan Virus and its various mutants emerging in the world. India’s success in being transparent in the trials of the vaccine and its efficacy is India’s strength in leading the vaccine diplomacy and emerge as a leader. However, India cannot let its own population face the second wave of the pandemic by short supplying the vaccines in India to its 1.35 billion population meet world’s requirements of over 7 billion population. It needs to secure its own borders from the Chinese Wuhan Virus before it can free the world from the invasion of the virus. This means, India need to repriortise its Vaccine Diplomacy strategy. New emerging is that India has slowed down or halted the supply of the vaccines to the world’s after around 65 million doses supplied already.

India’s Vaccination Strategy

India has already used around 65 million doses for covering around 65 million people (around 2% of India’s population) since the launch of the program in January 2021. The phased roll out of the immunization program is on the basis of age cohorts. After the front-line medical workers, the senior citizens were the first to be covered under the program. The second phase is underway covering population above the age of 45 years. The for India is to immunize over 250 million of its citizens by July 2021. Let’s analyse this scenario in the face of the second wave emerging.

Optimum Population Immunisation Coverage

It is believed that over 50% of the population immunized is the much comfortable situation for any country to manage and control the Covid pandemic. While no country has reached this so far, around 20 countries has performed better in their population immunization drive so far. UAE, UK, Chile, and the US have immunized over 20% of their population. The rest of the 16 countries faring better than India also are accelerating their vaccination strategy by ramping up the procurement and supply of vaccines. India has to also do the same.

Revised Vaccination Strategy in the Face of the Second Wave in India

While India may take some time to reach the 250 million population coverage by July 2021, it must rethink the vaccination coverage strategy. Here are a few suggested ones which obviously do not meet the cannons of vaccination in the face of a global pandemic never faced by the world before.

Total Vaccination of Population in States with the highest Covid outbreak:

In this scenario, India accelerates the immunization and opens it to all the age cohorts in the top-5 states which are contributing to over 80% of the current second wave of cases. These states include Mahrashtra, Kerala, Delhi, Karnataka, Andhra Pradesh, Tamil Nadu. This is going to be politically sensitive as other states which have better managed their Covid situation may let the current situation slip to demand total immunization coverage of their states

Total Vaccination of Population in States with the highest Covid outbreak:

Like the earlier strategy, the top 20-cities are contributing to over 50% of the second wave of the Covid cases. This may also be difficult and politically sensitive.

Open up the double bell curve of the Indian age cohorts at Risk:

At a median age of 27 years, its our 50% of the younger population which has to also be opened up for the inoculation strategy as newer mutations attack this population which is our country’s future productive resource.

While the above vaccine strategy would lead to some amount discrimination and political horse trading. Its time to our review and acceleration of the vaccine strategy. The vaccine strategy adopted by other countries as a benchmark would be another blog for another time. The priority of the immunisation strategy is to avoid another impending lockdown to control the spread of the Chinese Wuhan Virus infections!

Science of Politics of Covid Vaccine in India

Covid Vaccine Politics

Background

India has finally developed a vaccine for Covid which was approved by the regulatory authority the DCGI and it now the front runner for production of vaccines in the world. This is a great moment for India’s scientific might and I want to congratulate all the scientists who have worked tirelessly to deliver this solution to fight Covid to the world. Let me tell you that having worked in the drug development industry and also on the boards of several pharma companies, and biotech industry policy making, all efforts of the scientists are guided towards drug safety and efficacy before the final vaccine candidate is commercially produced for the masses. In the last 24 hours, leaders of several political parties have placed their roles in shamming and shaming the Indian scientists on the Covid vaccines being approved by the regulators in India. Let me inform you that Indian scientists do not work for political parties, they work for the advancement of science and technology. In this blog, I want to debunk some of the politics going on around our Covid vaccine and the timing of their political statements

The Political History of Bharat Biotech

Bharat Biotech whose vaccine Covaxin started in 1996 in the Genome Valley in Hyderabad. At that time the Deve Gowda Government with the support of Congress was at the center and the Telgu Dessam Party (TDP) was ruling in Andhra Pradesh. Let me remind the leaders of Congress who have come out with some statements, why did your Minister heading the Department of Science and Technology under which Department of Biotechnology (DBT) comes in provide grants to such a company if you believed that today that company is a fraudulently and premature in producing a vaccine for Covid. Over the years under the Congress rule, Bharat Biotech received some many grants and awards from the DBT to further their development of various vaccines. Infact BIRAC an arm of DBT also owned equity in Bharat Biotech at some point in time for the funding that was provided to Bharat Biotech by the Congress Government. I had been associated with the DBT and the Principal Secretary, DBT during the Congress Government who I worked closely to deliver the Biotech Ignition Grant Policy to the nation. He was very appreciative of the work Bharat Biotech had done and achieved several milestones in its journey with several vaccines and patents.

The Science into Politics – Way Forward

Rather than making baseless statements around the vaccines being approved, its time political parties appoint a Chief Scientific Advisor like they had Chief Economic Advisors in their party. The job of this Chief Scientific Advisor and his team would be to sieve through the clinical data presented to the regulators DBT, DCGI and other departments and raise scientific issues and challenge the science on the floor of both the houses of the Indian Parliament through their elected party representatives rather than make frivolous public and press statements outside the house. This would imbibe science into politics and allow for the ruling political party of the day to address any issues relating to the science of drug development through the right governance mechanisms of our Parliamentary Democracy. All I must say here is: Dear Politicians, please do not debunk our Scientific progress for your political gains and headline statements for your parties and your social media impressions and eyeball. In the eyes of science, you all have been marginalized completely.

Jai Hind!

For more information on Covid Vaccine also visit:

Covid Vaccine | Kapil Khandelwal (KK)

Sustainability of Digital Health | Kapil Khandelwal (KK)

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