Changes to Coronavirus Diagnostic Criteria Result in Confusion

Health Care No Comments

For the second time in over a week, China has changed its criteria for confirming coronavirus cases, thus resulting in a dramatic decrease in new infections.

The new criteria exclude patients from Hubei Province, where cases are diagnosed using clinical methods, including CT scans and assessment of symptoms. Instead, patients there would be considered as having contracted the virus only when it is confirmed by a specialized nucleic acid test.

Making use of the new criteria, some 349 new cases were recorded in the previous 24 hours, taking the total figures for the country to 74,576. New deaths surged by 114 on Wednesday, bringing the death toll to 2,118.

The government would now distinguish between “suspected” and “confirmed” cases. Cases would be considered as confirmed only after genetic testing. These tests take about two days for the results to be processed.

Meanwhile, Japan recorded deaths of two passengers who had been on board a quarantined cruise ship.

The two passengers from the cruise ship quarantined in Japan have died after contracting the novel coronavirus. These represent the first deaths among the over 600 people on board the cruise ship who had been infected.

Both the deceased patients were Japanese; an 87-year-old man and an 84-year-old woman. They were taken to hospitals on February 11 and 12, and both had underlying health issues. [Excerpts from New York Times]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Trust in todays patient-doctor relationship

Health Care No Comments

On Monday, I was invited to participate in Apollo Republic Health Conclave and there was a discussion on trust deficit in today’s patient-doctor relationship.

Over 2 crore people are seen by doctors daily, which amounts to 730 crore patients in a year. Incidents of major violence occurring once or twice in a year do not amount to calling mistrust against medical profession as a widely prevalent issue.

On one hand, there is a need to have a strict anti-violence law within the purview of Clinical Establishment Act or National Medical Commission Act, and on the other hand, we also need changes in the way patient-doctor relationship is thought of today.

We all know there are four types of patients and all need different handling.

First ones are ignorant patients who have 100% faith on the doctors and go by their decision.

Second are informed patients with some science background. They are aware about illness and wellness and need proper counseling.

Third are empowered, Google-friendly patients who would not only like to be counseled but also want to be a part of shared decision-making.

Fourth are the most important and the enlightened patients who believe in taking multiple opinions both nationally and internationally and believe more on Google than on an individual opinion.

All categories may get hurt if their respective trust is lost. Their expectations are also different.

Most of the educated people today want a shared decision as they are educated and empowered.

In medical practice, we also need to take lessons from the way advocates and judges practice. They dont believe in spot decision or diagnosis even in emergent situations. They take time to listen to arguments, reserve the order and when in doubt, often take a joint decision by a number of judges sitting together.

We also need to learn from the judicial system that to review a case, it must be filed in front of the same judge and not the second judge. All judges know that individual opinions may differ. To file a review, you must approach a double bench and not a single bench. If you are still not satisfied, you can appeal to a full bench.

When a patient comes to us, he has not come to us for a life he has lived but for advice for a life which is yet to be lived. Therefore, for us, his age is 100 – present age and we should plan a Wellness plan for him to live rest of his life and not only concentrate on his present illness alone.

Vedic medicine has taught us that there are two states of mind – sympathetic and parasympathetic. Every patient or his/her relation is in a state of acute stress or a sympathetic state of mind and needs both treatment and counseling at the same time.

We also must understand from principles of Bhagavad Gita that a person in acute confusion like Arjuna will require multiple sessions of counselling, like 18 such sessions between Arjuna and Krishna.

Doctors are considered next to God and therefore they have no right to be in a sympathetic state of mind while treating a patient. They need to relearn staying in parasympathetic state of mind. The two main components of parasympathetic state are beneficence and non-maleficence.

Two sympathetic states of mind interacting with each other will only end up in a disaster.

Sympathetic state of anger or ego lasts only for 10 seconds and is hence, manageable and preventable.

What the patients expect is ALERT (acknowledgement, listen to them, explain to them, review what they have understood, and thank them).

Dr KK Aggarwal,

President CMAAO, HCFI and Past National President IMA

COVID-19 in pandemic alert period phase 5-6

Health Care No Comments
  • So far COVID-19 is a “public-health emergency of international concern.”
  • The World Health Organization (WHO) definition of a pandemic as “the worldwide spread of a new disease.”
  • It is also characterized by a lack of available treatment, a lack of human immunity, and ability potential to spread from person to person.
  • According to the US Centers for Disease Control and Prevention (CDC), a pandemic disease spreads across “several countries or continents, usually affecting a large number of people,”.
  • Virus outbreaks can be characterized as a pandemic if the disease is “markedly different from recently circulating strains” and if “humans have little or no immunity” to it, as per the UKs Health and Safety Executive.
  • A disease is termed a pandemic when it can infect several humans across a large area, can transfer from person to person, and cause clinical illness.
  • Epidemic, on the other hand, refers to a localized or regional outbreak, rather than on a global level.   According to the CDC, an epidemic is an “increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.”  The WHO defines an epidemic as the “occurrence in a community or region of cases of an illness, specific health-related behaviour, or other health-related events clearly in excess of normal expectancy.”

COVID-19 may have originated at the Huanan Seafood Market in Wuhan, Hubei, China. There have been over 1,775 deaths. This virus is transmissible from human to human. The Chinese government has placed Wuhan and the surrounding cities on lockdown. The disease has already spread to 29 countries. However, the WHO has not yet declared this as a pandemic.

The WHO mentions a six-stage classification describing the process by which a novel influenza virus moves from the first few infections in humans through to a pandemic.

It begins with the virus mostly infecting animals, with a few cases of animals infecting people. The classification then moves through the stage where the virus starts spreading directly between people and ends with a pandemic when infections from the new virus have spread globally.

A disease or condition is not termed a pandemic only because it is widespread or kills many people; being infectious is a key criterion. For instance, cancer causes many deaths but is not considered a pandemic because the disease is not infectious.

WHO classification of Influenza Pandemic

Phase 1 no viruses circulating among animals have been reported to lead to infections in humans.

Phase 2 an animal virus circulating among domesticated or wild animals has caused infection in humans, and is considered a potential pandemic threat.

Phase 3 an animal or human-animal influenza reassortant virus has led to sporadic cases or small clusters of disease in people, but has not caused human-to-human transmission sufficient enough to sustain community-level outbreaks. Limited human-to-human transmission may occur under certain circumstances, for instance, close contact between an infected person and an unprotected caregiver. Limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to result in a pandemic.

Phase 4 verified human-to-human transmission of an animal or human-animal influenza reassortant virus with the capability of causing “community-level outbreaks.” Thi potential to cause sustained disease outbreaks in a community signifies a significant upwards shift in the risk for a pandemic. Any country suspecting or having verified such an event should consult with WHO in order to facilitate joint assessment and decision-making by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 points to a considerable increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 human-to-human spread of the virus into at least two countries in one WHO region. The declaration of Phase 5 strongly points out that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6 – the pandemic phase. Community level outbreaks in at least one other country in a different WHO region besides the criteria defined in Phase 5. Declaration of phase 6 indicates that a global pandemic is under way.

Post-peak period – pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. This period signals that the pandemic activity is decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been marked by waves of activity spread across months. Once the level of disease activity declines, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and it would be premature to give out an immediate “at-ease” signal.

Post-pandemic period – influenza disease activity will have returned to levels normally seen for seasonal influenza. The pandemic virus will be expected to behave as a seasonal influenza A virus. Maintaining surveillance and updating pandemic preparedness and response plans is key. An intensive phase of recovery and evaluation may be required.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

« Previous Entries