COVID Models to Know Future Numbers (For attention of Doctors)

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Case fatality rate:Number of deaths/number of cases, As on 5 pm 23rd March, 14924/345289 = 4.32 %
Correct formula: CFR = deaths at day.x /cases at day.x-(T), (where T = average time period from case confirmation to death, which is 14 days)
Deaths on 23rd March = 14924; Cases 14 days before 10th March = 114381

Correct CFR = 14924/114381= 13%

Deaths in symptomatic cases= 1-2%, Number of deaths X 100= expected number of symptomatic cases
Symptomatic casesx 50 =number of asymptomatic cases
Total expected number of cases: Italy scenario: 978/million population (0.1% of the population), China scenario: 56/million population, Switzerland scenario: 1000/million population, Average scenario 46 per million population, Average scenario India: 50 per million population
Expected Number of cases after seven days
Number of cases today x 2 (doubling time 7 days, normal spreader)

Number of cases x 6 (Doubling time 2 days, super spreader)

Number of cases expected in the community:We can look at the number of deaths occurring in a five-day period, and estimate the number of infections required to cause these deaths based on a 3.3% fatality rate.
We can then compare that to the number of new cases detected in the five-day period 17 days earlier to estimate the proportion of actual cases that were detected 17 days ago.

This will give us an estimate of the total number of cases, both confirmed and unconfirmed.

Lock down effect = reduction in cases after average incubation period (5 days)
Lock down effect in reduction in deaths: on day 14 (time to death)
Requirements of ventilators on day 9: 3% of number of new cases detected
Requirement of future oxygen on day 7: 15% of total cases detected today
Number of people which can be managed at home care: 80% of number of cases today; Requirements of ventilators: 3% of number of cases today
Requirement of oxygen beds today:15% of total cases today
Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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CMAAO COVID Guidelines for doctors

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Health care professionals should be flexible in their professional behaviour in face of the significant epidemic.
Readiness to work outside the comfort zone of clinical practice in the increasingly likely scenario of widespread community transmission of COVID-19.
Primary and secondary care undergoes extreme stress during significant epidemic state. This leads “inevitable exacerbation of staff shortages due to sickness or caring responsibilities” and hence represents a challenging scenario for the profession.
It may include working in unfamiliar circumstances or surroundings or clinical areas outside of their usual practice for the benefit of patients and the entire population.
Every patient entering the hospital should be considered as COVID positive and health care professionals should wear mask all the time.
Encourage tele or video conferencing or consultations as far as possible.
Inform through SMS all the patients to not visit the hospital/clinic if they have cough or fever. They should only do so after fixing an appointment.
All patients with cough and fever entering the hospital should be immediately provided with a surgical mask at the reception, and given priority getting lab or imaging tests. They should not be made to wait in queues.
All reusable equipment stethoscopes, BP instruments etc. should be frequently sanitised.
Minimise paper work as much as possible.
Learn the correct method of using and disposing surgical masks.
Read the updated MoH guidelines every day.
Best mask for coronavirus in Hindi ,Symptom of Coronavirus in India ,Prevention of coronavirus in Hindi

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Language Barriers

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With doctors at the receiving end of violence, their skills should also extend to knowing three languages so that there is no miscommunication about their diagnosis

Recently, an altercation took place between activists of the Karnataka Rakshana Vedike and a postgraduate student at the Minto Ophthalmic Hospital in Bengaluru over language. The student did not respond in Kannada to their demand for compensation for patients blinded during a cataract camp simply because he did not speak Kannada. The matter has taken a political turn, with doctors going on strike and demanding enhanced security and action against the activists. The incident has sparked a national debate on the issue of language barriers in medical education in India.

Admission to medical colleges in India is based on common admission tests. The centre allocates seats to students in various colleges from an all-India quota. Unlike Ayurveda where the medium of education is Sanskrit, in allopathic medical colleges, it is in English. Even in the Supreme Court, the language is English. No one should expect students to learn the local language as soon as they enter a medical college. It could be a language they are completely unfamiliar with.

I did my undergraduation and post-graduation from the Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, in Maharashtra where the local language was Marathi. I learnt Marathi during my college days but only as much as was needed for patient care. Ward boys and other staff would be our interpreters if we got stuck on any word.

However, some European countries such as Sweden have made it mandatory for doctors to learn Swedish if they want to practise there and many Indian doctors have done so by taking a course to demonstrate that they have reached C1- level Swedish. In 2010, the Eastern Mediterranean Health Journal touched upon the perspectives of students and staff on language barriers in medical education in Egypt and their attitude towards Arabization of the medical curriculum. In a survey of 400 medical students and 150 staff members, it was found that 56.3 percent of students did not consider learning medicine in English an obstacle, while 44.5 percent of the staff considered it an obstacle only during the first year of medical school. Some 44.8 percent of students translated English terms into Arabic to facilitate studying and 70.6 percent preferred to learn patient history-taking in Arabic. While Arabization in general was strongly declined, teaching in Arabic was suggested as appropriate in some specialties.

Thankfully, India does not have strict rules on language. Dr OP Gupta, my Professor of Medicine at MGIMS narrated what a colleague had told him. “I was examiner in one of the colleges of MP where I found that some students could not communicate well in English. But when I explained the questions in Hindi, they answered them with ease,” he said. So should language be a barrier for treatment? No.

Gupta further said: “I had a similar experience when I used to go as an examiner for final-year students. Even when I have a bedside discussion about a patient with students, sometimes I have to explain in Hindi. With English as a medium of instruction in medical education, a perceptible gap in communication is noticed. If a learner cannot understand the language of instruction, it becomes difficult, if not impossible, to grasp the content.”

In a sign of changing times, the National Eligibility Cum Entrance Test (NEET) 2018 examination was conducted in 11 languages. While 80 percent of the students wrote the exam in English, 11 percent did so in Hindi, 4.31 percent in Gujarati, 3 percent in Bengali and 1.86 percent in Tamil. About 20 percent of the 1.1 million students who appeared in NEET wrote in regional languages. NEET 2019 rules stated that the exam would be conducted in English, Hindi, Urdu and eight regional languages (Bengali, Assamese, Gujarati, Telugu, Marathi, Tamil, Oriya and Kannada). The regional language question papers would be bilingual.

However, it would be a good idea for all doctors to study one international language. As medical tourism is on the rise, that international language should be English. As it is also the medium in books and for teaching, they might as well learn it. To promote medical tourism, the government is also making it compulsory to have interpreter assistance at all levels. Recently, when I travelled to Japan as president of the Confederation of Medical Associations in Asia and Oceania, an interpreter was provided so that I could talk to my Japanese colleagues. For domestic medical tourism too interpreters should be made available in the hospital set-up in every state to facilitate communication between doctors and patients.

The second language for doctors to learn is the one most commonly spoken in the country. In India, it will be Hindi. The third language should be the local language where one is practising. The students themselves should learn it. That will be difficult unless the student devotes a full year to language learning or there are interpreters in hospitals.

These measures are necessary in order to stem disputes and arguments between patients/their families and the doctor. It is also needed to prevent deficiency in medical treatment due to wrong interpretation of symptoms. This may lead to wrong diagnosis and wrong treatment. The National Medical Commission should take these points into consideration and mandate local interpreters in the hospital setting.

Coming back to the violence against doctors, no one has the right to attack them for not knowing the local language. Doctors on duty are akin to pilots and flight attendants and any distraction from work can affect the pilot and jeopardise the lives of passengers. Similarly, any distraction in the treatment provided by doctors because of unlawful elements should be strictly prohibited and they should be arrested.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

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