Saturday, April 4, 2020


   I know that everyone is saturated with the information on COVID -19. But I have seen many things on TV  and radio and in general public that I thought I will write some of the things. We all know that the the virus originated in China . The theory that it started with animal market is debunked as I understood there is no bat- horseshoe bat ?? within several miles of the city Wuhan china where this all started . But there is a virology lab. This does not matter for the pandemic but certainly matters for the future as if it did originate in lab  and  accidentally escaped and infected people that is worth concern for any and all virology Labs .
   I have heard also that we were not prepared for this emergency. I am not sure what any country could do for such a magnitude of cases  and such a virulent virus. We have several issues that caused the problem and not all the talking heads are talking about it. We also need to understand that the understanding of virus  and the way it spreads is changing every day. So let me give  an example . I had done classical music concert for a great artist . I had a call on Sundat to see if I could arrange it for Tuesday. Tuesday being week day I was not sure how many people can attend. So at the end of Monday evening we had only 30 people who agreed to come . In view of such a small number  and cost of renting hall and arranging mikes etc , I decided to do it in my house . I had 30 chairs  and I could do it easily in my house  and I had microphones etc . On Tuesday, 60 people showed up. So did I have enough chairs? NO , So do you think I was not well prepared ? I think this is what has happened  and we will never be prepared for what happened  with COVID .
     Let me explain. The COVID was thought to be a droplet spread virus. So when the infected patient who coughs or sneezes he throws out droplets  and they will settle down on surface - gravity effects . So way in which I can get it , is by touching the surface where droplet is there  and then having virus on may hand  and then when I touch my mouth or nose or eyes - mucous membranes , I will get infected , So if II wash hands, I will not get infected. So the mask will not protect . But things changed . NOW WE KNOW THAT THIS ONE CAN BE AEROSOL SPREAD . This means viral particles will float in air  and when one breaths the air which has these particles , he will get the infection. So the mask is helpful. THIS ALSO MAY WHY WE HAD MORE INFECTIONS THAN WHAT WE COULD EXPECTED BASED ON DROPLET TYPE OF SPREAD  AND POLICY FOR MASK USE.
    The need for more Ventilator or respirators . As I mentioned before I can never be prepared for 60 chairs in my house , same with any hospital and even government . If we have big stock pile of ventilator , who is going to pay for it . Private industry can not afford buying them and not needing them for years and then if not maintained then they don't work . Secondly the change of policy for who needs to be on Ventilator. When we see a patient with pneumonia who needs oxygen, we start oxygen at flow rate of 2 L per min. and then increase it to 4-5-6 . If that is not enough we continue to increase to 15 L . then we can switch to what is called HEATED HIGH FLOW - may be 40 Lor moreas needed. . If that is not enough then we try BIPAP slimier to what is used in patient with sleep apnea. The only difference is that it can be attached to 100% oxygen and also we can add rate and other things that ventilator can do .The advantage is we do not have to put tube down the throat in to lungs and sedate patient . SO IT DOES NOT NEED VENTILATOR . The problem is all theses steps that we normally use before using ventilator CAN NOT BE USED DUE TO AEROSOL NATURE OF SPREAD . So anybody who needs more than 6L oxygen gets on VENTILATOR.and anybody who is on ventilator needs sedation and needs to be in ICU . Now you know why we need so many ventilators.
    SO the question is what is in future ?I don't know . But one thing for sure it has  knocked out the economic boom that we have had. I am  an optimistic  and feel that in next 3 weeks or less we should be turning down or may be flattening of curve. As of today this  has not happened . But reasons that I believe we will start getting better after middle of April .

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