In India as of 19th Jun 2021, though we have had many cases of COVID-19 across the country, affecting all strata of society (2,98,23,546 cases to date- as per mohfw.gov.in) , to give us a reality check, just about 2 out of every 100 Indians has experienced the disease, and the large majority of those, have got through unscathed with mild or asymptomatic infections. Maybe an even larger number did not get diagnosed, but suffered all the same. This would indeed be the most likely scenario given the state of reporting of diseases and the fragmented healthcare system.

By now, over a year and a half into the pandemic, we may personally know someone who has had COVID-19, or we may ourselves have been affected.

Even if you have been infected, and recovered, you still need to wear a mask at all times, when interacting with others, while maintaining physical distance. It is also advisable to take the vaccine (any), about 90 days after recovery. However, do check with your doctor, as these recommendations are evolving and updated frequently by the Govt of India based on emerging evidence.

If you are one of those who has recovered, you need to pay special attention to avoiding known long-term effects on your respiratory system, by continuing efforts at deep breathing exercises and eating healthy.

Bottomline Those who have recovered from COVID-19, can get infected again. They need to continue COVID Appropriate Behaviour and take a vaccine when available / when due.

Recovery and restoration of baseline health and fitness after COVID-19 is a challenge for many. Fortunately, a sensible approach will reap dividends when prudence is kept the bedrock.

For those who have never exercised or just waddled their way through life so far, before COVID, this is the time to seriously consider taking up some form of exercise that is sustainable. Do not rush into a gym membership, or buy that expensive cycle, without first figuring out what should be the path to exercise that you will tread on nimbly, in the decades ahead, to stay healthy.

For those of you, who were “into fitness”, reconsider your goals, and reset your standards.

You must and should take it slowly!

“Listen to your body” – this is keystone of any approach that you choose to adopt in the days ahead.

We have become accustomed to hearing ever so often, “No Pain, No Gain”, however our new lexicon has to adapt and evolve to the new mantra “Pain, No Gain!”, meaning that if you are finding any exercise or exercise level ‘hard’, it is definitely not good for you, especially if you are recovering from COVID-19!

If you have any medical problem with your heart from before, or had any effect on your heart while you were sick with COVID-19, it is essential that you consult an allopathic medical professional to ascertain your fitness to resume physical exertion.

Please get active!

Note to Self: this is different from exerting! Whatever your medical condition, you will benefit from making a beginning, with baby steps at first, to move around. Begin first by getting around your house, indoors, and then move outdoors. Exertion can be a later step.

You can begin with deep breathing exercises, do these at home, while seated comfortably, do these daily. Applicable for everyone, irrespective of whether you have had COVID-19 or not.

Bottomline
Now is the time to contemplate taking up some form of exercise in a graded manner after you recover from COVID-19. Listen to your body carefully. Don’t push yourself!

Modern times, pandemic times, as people constantly in search of quick fixes, for everything in our life, we would be searching online for what we can do to get back into ‘shape’ (whatever that may mean to you personally!) . Hence this next section is just what the doctor prescribed!

Your health is in your hands (or your legs), but every journey in your life, begins with making up your mind first! You are the one who has to undertake all required actions to keep yourself healthy and well.

So, why waste further time. Just do it!

Exercise is beneficial not just for promoting recovery from COVID-19, but also serves to safeguard you from many lifestyle and other diseases.

The right time to start is now.

Bottomline
Exercise is good for you. Begin any exercise with the intent of sustaining a healthy lifestyle through old age too.

Just begin whatever it is you choose to do, today. Listen to your body , while at it!

Please do share the above info sheets with your family, friends and colleagues. And do suitably translate and convey verbally to those around you who will benefit from it.

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After having lived through these pandemic times since early 2020, by now, irrespective of where we are in our lives, or where we are in India or in the world, we would have begun to appreciate that health is the only true wealth we can possess. 

We would now be acutely aware of the importance that Wellness has for our Wellbeing.  However, the human mind is rather fickle and we will just as easily forget the hard learnt lessons of today. 

Wellness and Wellbeing are in your hands!

 Stress is an inescapable part of our lives today, with the unfolding pandemic keeping us on tenterhooks. In normal times, a modicum of stress would always be welcome, to keep the excitement level up. However in these challenging times, we worry every day, for ourselves, for our loved ones and some may even worry for humankind in general.

Periodically, we need to take a deep breath and look within, to find strength, for ourselves and others. Having a daily routine helps, it gives a structure to our day, it may even give us a semblance of the feeling that we can at least control some part of our existence.

We must all try to find our own ways to strike a balance, however impossible that may seem. We can start with simple steps, such as writing down a routine, for us to broadly follow, the best that we can. 

A daily routine helps in dealing with the stress of life in these challenging times.  

In these stressful times, we may have also begun to appreciate that peace of mind is invaluable.  We have to tap into our innate strength (yes, all of us have reserves of emotional and mental strength, which we may not be aware of) and get through each day, with a positive frame of mind. 

Think positive (attitude), Stay negative (Corona).

Use simple approaches such as the 5 Cs to work on yourself. You have the ability, believe in yourself. 

The ongoing pandemic is undoubtedly one of the most challenging events of our lives, and its prolongation is only compounding the difficulty of coping.

We need to recognize and acknowledge that all of us handle stress differently. We need to learn to handle the situation within the context of our personal and work life. Work-Life Balance seems to be a very simplistic term, however it is most crucial for us to strike a balance that works for us as individuals.

More than anything, this pandemic has taught us that we need each other more than anything else in the world. We need to reach out more, to our loved ones, to our friends, to our relatives, to our colleagues. Reach out often, simply through a personal message (and not a forward) or a phone call. Just do it!

Please do share the attached info sheets with your family, friends and colleagues. And do suitably translate and convey verbally to those around you who will benefit from it.  

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Most of us are fully conversant with COVID Appropriate Behaviour by now, and are aware of what all is being done and has been done by the Government and other agencies to control the pandemic, with varying degrees of success.

Just to remind you, COVID Appropriate Behaviour, i.e simply correctly wearing a well fitting mask consistently, washing our hands periodically, not touching our face (mouth ,nose, eyes) often, keeping physical distance from others, avoiding close contact, crowds, and crowded places, works well for adults, and for children too. 

However, what can help to more effectively control the pandemic and mitigate its impact, is, if all of us periodically disseminate suitable and consistent messages within our circles of influence, and motivate our families, friends and relatives to do so similarly.

The first Five Key Messages , are important to be disseminated to those in our lives with whom we interact with regularly, including our domestic assistants, our building security personnel, the housekeeping staff, vendors and shopkeepers. These five key messages, if adopted uniformly by society at large, will possibly be decisive in halting ✋the coronavirus pandemic.

The next Two Key Messages, are about stigma and discrimination, which we need to focus on as the days unfold into weeks and months of the ongoing pandemic.

First, there was stigma and discrimination about cases, amongst those infected and those not infected, now there will be the same divisive issue about the vaccinated and those not vaccinated.

We can be victorious ✌ only when we overcome these petty barriers that stigma and discrimination pose for us as a society.

We all will be safe, when everyone is safe! That’s the catch with any measure that is to be instituted / implemented for pandemic control.

The most important one is saved for the last!

The one Key Message to hopefully vanquish the Coronavirus is the latest weapon we have, ‘the vaccine‘!

Don’t Hesitate, Vaccinate.

We need to strive to get everyone vaccinated.

In everyone’s safety, lies our own safety.

Bottomline
Use every opportunity you get, to spread the 5 + 2 + 1 Key Messages to all those you know.

Not just once, but again and again.

Please do share the attached info sheet with your family, friends and colleagues. And do suitably translate and convey verbally to those around you who will benefit from it.

Your family, your friends, your colleagues, we all need YOU, yes, 👉you ! to take action, Today!

Please connect with me if you would like to organize an orientation or training session on dissemination of these Key Messages , for your teams / organization.

Each one can reach many!💪

In June 2021, daily, we are inundated with dire predictions about a ‘third wave’. Social media is in a frenzy commenting on the threat to children, parents across India are rightly perturbed. Is this all hype and hoopla?

The honest truth is that no one, not the armchair epidemiologists, not the mathematical modellers, not the ‘big doctors’ from premier national institutes, not the savvy media pundit – No one can predict with any level of certainty, whether we will experience a third, fourth or fifth wave. Going by the experience of the 1918 Spanish flu pandemic, it is reasonably certain that we will definitely experience waves of unknown magnitudes, over the coming months, before life comes back to as close as we can remember it to be normal.

Now, what about the news snippets of the likelihood of our children being affected more in upcoming waves?

Well, children have been affected in the first and second waves too, and paediatricians have found that symptomatic infections are far fewer in children as compared with adults. And that the disease is also less severe. Undoubtedly, there have been cases of severe disease amongst children, however not at such an alarming rate to cause apprehension.

The Indian Academy of Paediatrics came out with a guidance statement on 22nd May 2021, which they have assured will be updated as and when new information comes to light. This statement is reassuring from the point of view that the apex professional body of paediatricians in India, has given evidence based statements in an easy to interpret format even for the non-medical individual.

Children benefit from the protection of their parents no doubt, however children still need to be guided suitably in fully adhering to COVID Appropriate Behaviour as applicable for adults, i.e. Masks, Hand Hygiene, Physical Distancing.

As a parent, if you are anxious about “MIS-C”, don’t worry, a future infosheet will address this suitably, next week.

Bottomline
COVID Appropriate Behaviour (CAB) as applicable for adults is equally appropriate for children. With no vaccine available as yet for children, CAB is what will keep them safe.

Please do share the attached info sheet with your family, friends and colleagues. And do suitably translate and convey verbally to those around you who will benefit from it.

In case you need any additional info on any topic or theme, please connect with me directly.

The above picture refers to an Op Ed by a senior colleague , who is an eminent epidemiologist, and well known in academia. It is a very well conveyed perspective on the ‘Pandemic of Panic’ being reported everywhere ( I recommend a click on the link given below the above image to read through the write up).

We are constantly being bombarded with saddening images of public distress across India and accusatory media personages indulging in the blame game. If you would cast your memory back to the early days of the pandemic, ,you would remember that the coverage of the pandemic in Italy and in the USA was similar. Now it seems that the world media is fascinated with the Indian story, till something new comes along. In the modern times, everyone of us knows (or should know) that what we see on social media and the mass media is not what is and that what is , is not what we come to know of. Simply put, we have a large population, and we do not have adequate resources to match the requirements. This can only be addressed by advance planning and preparation over many years if not decades. However, it is never too late!

However, not to distract from the theme of today’s post! The one term that even a toddler in these times knows all about is – “The Pandemic Curve”. What with everyone wanting to flatten it, one can almost conjure up the image of homicidal burly people chasing some ephemeral curvaceous thing to flatten the life out of it.

This is how the chart showing cases in India and the USA looks like. if you see absolute number of cases only! Please note how it appears that India is having more of a problem that the other country with which it is being compared with. Our media prefers this format as it is more sensational. Please see the next chart which shows the same data as “Cases per million population” to see the difference the same data brings about when presented as per convenience of the presenter.

Source: Our World in Data website -Accessed 02 May 2021

The above two lines are for the USA and India respectively, and while you take a deep breath (yes, breathing deep is good for you at all times!), let me clarify that this data is representative of “Cases per million population” as on 01 May 2021. This is the preferred way to have a look at data, the way that scientists and epidemiologists do, (i.e to have a denominator, to lend perspective and ensure comparability between countries or regions). In the above case, population in millions is the denominator.

This image is for you to understand what these “waves” are all about…. You can straight off identify the ‘waves’ in USA…. and then look at the Indian wave(s) identifiable by the arrows. The data is “Incidence” i.e the number of new cases per day. You can see the shape form that the lines are conveying…. they look like waves dont they ? This is the ‘Epidemic Curve‘ , which is very happily referred to by everyone, when they talk about ‘flattening the curve’.

In the Public Health domain, those of us who are professionals and not WhatsApp experts or astro- forecasters, usually we cannot know whether we have crested the wave till after we have crossed it. To inform you, this kind of data is best looked at retrospectively. Data modellers who have proliferated during this pandemic, are amateur graphic artists who love to draw projections which progress beyond the curve…Their guesstimates are as good as a kindergarten kid with a crayon.

Now who can comment whether the curve will rise or fall at this point of time? That is conjecture and based on a lot of assumptions, most of which hindsight proves to be fallacious. Every wave has to have a crest. The crucial question is when will it be reached ? …

Data is only as good as what it can convey. Pragmatically, for an individual who loses a loved one, data doesnt make a difference. A loss is a loss, and requires our empathy. Lives in India are as important as Lives in the western world. This is what we must focus on going ahead.

Someone somewhere said this sometime “If we have data, let’s look at data. If all we have are opinions, let’s go with mine.” In this modern infodemic , everyone has an opinion. Mine is that we should be circumspect when we look at the data presented by Mass Media and circulated on Social Media. Rely only on authentic, verified information from credible sources. Peruse the interpretation of scientists and epidemiologists and then only form your own world view.

“Doctor, why should I get the vaccine, when I have already come out of a COVID infection (unscathed)?”

” I believe that natural immunity acquired through having been infected, is better than vaccine derived immunity….”

Well, again, on the lighter side of things, social media has educated a lot of people and given their opinions a stage! If only life and science were so simple !

Like a stuck record, I must repeat “We dont know enough about this ‘novel’ Coronavirus as yet, We dont know how it affects us in the medium to long term…..!” Do keep in mind that this virus has been causing havoc for just about a year now and it truly does take many years for indepth scientific information to be collated, analysed and assimilated into the knowledge ecosystem. As of now we are learning on the fly….. So, possibly , you and I know as much as the real ‘experts’ out there.

As on 18 Mar 2021, it is recommended that all people should be vaccinated regardless of whether they have already had COVID-19 in the past.

We do not know as yet, for how long we are protected from getting sick again (i.e repeat infection) after recovering from COVID-19. There have been numerous reports from across the world of repeat infections. Hence, it is important to be aware that even if you have already recovered from COVID-19, it is possible that you can be infected again by the coronavirus, either the original coronavirus strain or even the new mutant strains which are emerging. While you may have some / partial immunity to the original coronavirus, you definitely may not have any immunity against the new mutant strains. Immunity development is a very complex process and we can at best guess our individual responses, as the human body is unique to each of us!

By now everyone of us is aware that getting COVID19 is like gambling with a loaded gun….. You do not know with certainty whether you will get seriously sick or not if you are infected! Vaccination provides you immunity without you falling sick the way you would, if you were actually infected with the coronavirus. Hence if I were to choose with getting some immunity, I would prefer the vaccine route as compared to getting infected with the coronavirus and getting sick with COVID19. You can read the CDC recommendation here.

Vaccination should be deferred for four to eight weeks after recovery from a COVID infection. Do not be in a rush, however do get vaccinated in due course of time, to harvest the benefit of the protection of vaccine derived immunity.
Another question that will keep pestering us : “Does vaccination with currently available vaccines, protect me against the newer strains / mutated virus of this Coronavirus?”
Again, no simple straight forward answer for this one too. Yes, at the current state of evidence, there is a likelihood of the currently available vaccines, providing protection against the newer strains / mutated virus variants. However, do keep in mind, that the vaccines are presently understood to be protecting us against getting severe illness or falling seriously sick even if we get infected. In all probability they will not prevent the virus (old, new, variant etc) from entering the body, i.e we can still get infected and spread the virus to others (hence the need to continue COVID Appropriate Behaviour even after vaccination).

In case you are taking any medications (and not just blood thinners), it is advisable to consult your doctor on telephone , prior to going to a vaccination centre. There are far too many medications and combinations thereof, to address through a generic post like this. Do not rely on social media, instead count on direct communication with your doctor, before you go for vaccination.

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At present (18 Mar 2021), I will recommend that you should take whatever vaccine you can get in India (i.e Covishield or Covaxin ). Millions have already been vaccinated with these two vaccines. Safe to say that it is safe , as of now. I am not commenting about the current social media scaremongering about the Astra Zeneca (Covishield) vaccine and its supposed linkage with clots. As and when the data is sifted more thoroughly, the ‘truth’ will come to light. Will be reading up on the evidence as it comes through and will distill the same for you to read subsequently.

Vaccines save lives! There can be no further debate on this! Since the past 100 years or so, vaccines have transformed human survival in the ongoing fight against microbes . These vaccines are virtually the only specific protection we have against our microscopic enemies (i.e for those which we have vaccines against).

COVID-19 affects all age groups; however, morbidity & mortality is several times higher in adults particularly in those above the age of 50 years and those with co-morbidities such as Diabetes, Hypertension, Obesity (amongst a long list of such). Children usually have either asymptomatic or mild infection. The Govt of India has prioritized availability of vaccines (at present , in mid Mar 2021 subject to change in the days ahead) to those above 60 years and those in the 45-60 age group with specified co-morbidities. Eventually, as and when more and more of the ‘higher’ risk population is covered, the Govt will surely include the rest of the population in a phased manner, i.e all those above 18 years of age. Given the size of our population this will take a few months for sure. So if you are young(er) , have patience! Apna time aayega!

The currently available vaccines have not been thoroughly evaluated in children so far . There are now clinical trials underway to test the effectiveness and safety of the COVID 19 vaccines in children. Whenever this phase is satisfactorily completed, I am sure that the suitable vaccine will be provided for children too! There need not be ‘vaccine envy’ within a family…. it is essential for their well being to reassure young and old alike, that prevention remains best in the form of avoidance of crowds, crowded spaces and close contact. The vaccine is just another tool .

Side Effects : For those who have been vaccinated already (i.e those who have received even one dose of any COVID vaccine), there would have been apprehension about ‘Adverse Effects’ and ‘Side Effects’. For those who are yet to get the vaccine, there would be more apprehension, in case you have been reading about Adverse Effects or Side Effects in the news or through the Univ of WhatsApp. Relax, chill! Take a deep breath and a long sip of cool water!

Some mild symptoms may occur such as injection site tenderness, injection site pain, headache, fatigue, myalgia (muscle aches and pains), malaise (feeling unwell), pyrexia (low grade fever), chills and arthralgia (pain in joints), nausea (feeling vomitish). Please disregard media reportage of very rare events of disorders following vaccination with these vaccines. The rarer it is, the less likely that you will be affected !

Share in others misery : Here is a compilation of unedited comments from a cross section of people who received the vaccine in March from across India . For those who have already received a dose of the vaccine, you may relate to some of this:

“I was alright till I drifted off to sleep. At 5.30 am when I woke up, I had a severe backache- worse than ever. I could barely straighten myself. By midday I was running low grade fever- a complete day 0 for me. Next day slight backache persisted , felt better largely. Day 3 – I am ok.”

“I didnt feel anything at all! I even played 9 holes of golf the next day, and I am 72 years old”

“I started feeling dizzy by evening . I even felt disoriented and my body ache was horrible. Felt so feverish that couldn’t eat much. Next day I felt slightly better”

“My arm, where I had the shot became stiff and painful. Luckily I was fine otherwise. The pain became ok the next morning when I woke up”

“Through the day I stayed well- told myself “ you will be fine!” and then body ache started with fever- did I speak too soon? Only reason I forced myself to eat was to take a tablet”.

“What nonsense are people talking about, when I am feeling hale and hearty- these are all faint hearted people imagining reactions” , said some.

“I felt listless for the whole day- didn’t want to do anything at all, and then by evening I was fine”.

Recommendations for dealing with side effects : Firstly, please accept that side effects may occur. Next, avoid physical exertion for at least a day after the jab. Drink lots of water, eat nourishing meals and avoid alcohol or tobacco in the day(s) after the jab. If you feel slightly unwell, you can consider taking a paracetamol tablet (after something to eat, with a full glass of water). If feeling very unwell, consult your doctor on telephone sooner than later. [Its best that you be the judge of how ‘unwell’ you feel] You can have a look at this link to the CDC USA website giving you info about side effects…..

Common Misconceptions : “Alcohol cannot be consumed for upto 45 days after vaccination” Be reassured! If you are an occasional consumer of the spirit that cheers, do not get overly perturbed. Going by reports , this recommendation was essentially targeted at those receiving the Sputnik vaccine , as the consumption of alcohol in Russia is much higher than elsewhere, and it is a known fact that excessive alcohol consumption affects the immune system. My advice is “If you drink, drink less, If you dont drink , dont start!!” And, yes, definitely avoid alcohol on the day of your vaccination and drink less in the days afterwards, if its possible, better for your health overall, to not drink at all.

“Will I test positive on the corona test after the vaccine ?” Getting the vaccine will not make you test positive for COVID-19 on a Rapid test or a PCR test. If you test positive and it’s an accurate result, you were most likely exposed before you got the vaccine or before the protection kicked in.

“How long does it take for the protection effect of the COVID vaccine to set in?” This is still being studied and we will know for sure only a few months later. As of now, it is reasonably assumed that within two to three weeks after completion of a two dose schedule of the vaccine (whichever), some immunity will be established for sure.

“If I dont get any side effects after the vaccine, it means that the vaccine has not worked” Not true. Some people develop side effects, and some people dont. Which does not mean that the vaccine has ‘not worked’.

“Do I need to wear masks / follow other COVID Appropriate Behaviour after receiving the vaccine?” Yes, it is absolutely necessary that everyone who has received the COVID vaccine should continue to follow COVID Appropriate Behaviour i.e., Wear masks, Keep Physical Distance, and undertake frequent hand sanitization to protect themselves and those around from spreading the infection.

“How long will I remain protected after vaccination?” Longevity of the immune response in vaccinated individuals is yet to be determined as there is not much we know about the duration of protection , given that this coronavirus and its vaccine is new on the scene.

“I had COVID last year, hence I do not need the vaccine” The current recommendations are for people to be vaccinated irrespective of their past history of having COVID, with a gap of at least a few weeks after having recovered.

“I have been vaccinated, now I am safe, I will not get infected ” Not true. The vaccine is just going to protect you (hopefully) to some extent from getting seriously sick. The vaccine doesnt prevent you from getting infected and spreading it to your loved ones. You still can get infected with the virus and can even become an asymptomatic carrier.

Please share this post with your friends and family. Let us work together to dispel misconceptions and address vaccine hesitancy. Please post your additional queries in the Comments section for these to be addressed in subsequent posts.