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29 Jun, 14 tweets, 12 min read
📋CLINICAL MANAGEMENT PROTOCOL: COVID-19 by GoI, @MoHFW_INDIA provides guidance to #COVID19 medicare and mgmt units all over India.

❗️Essential to be FACT-based, well-INFORMED, UPDATED.

⚠️Sadly, its not well-informed or fact-based. Needs URGENT UPDATE/REVISION now. e.g., 👇 Image
❗️Some MISINFORMATION based on outdated @WHO's surveillance guidelines & info (~March '20).

❗️Ignored information post mid-March from EU, USA, India though these form major % of total cases.

❗️ECOLOGICAL FALLACY.

❗️Systematic CALLOUSNESS.
\2 Image
❗️SARS-CoV-2 transmitted from HUMAN-to-HUMAN by infectious droplets, arguably AIRBORNE & ocular mucosa (may also be Faecal-oral).

❗️Asymptomatic: Infected but will never show symptoms.
Pre-symptomatic: Infected & will show symptoms eventually.👇 \3 ImageImageImageImage
⚠️Incubation period (period between infection and onset of symptoms): Mean incubation period est. ~ 4-7 days. Range 2-28 days. Most cases incubation period lies b/n 1st to 3rd week (depends on individual ability and exposure to virus load). \4 Image
⚠️NO COMMUNITY TRANSMISSION allows #COVID19 medicare & lab units to DENY diagnosis tests of (genuine) suspect cases. Heavily UNDER-REPORT deaths & cases as it narrows window for tests of patients w/ symptoms & their contacts, gives free hand to states. \5 Image
⚠️ @WHO: " Countries may need to adapt case definitions depending on their local epidemiological situation & other factors." Yet our protocol update 13/06/20 based on @WHO's 20/03/20 report.

❗️COMMUNITY TRANSMISSION in ON.

❗️Huge VULNERABLE popn. \6 Image
⚠️Crucial symptoms requiring URGENT medical attention missing from @MoHFW_INDIA's clinical protocol, e.g., chest pain.

Evidences of hospitals denying tests & appropriate medical attention since protocol itself is misguided; leads to undue stress/death.\7
ImageImage
⚠️HIGHLY likely that -ve person will turn +ve in isolation room if distance b/n two patients is less than 6 meters & 3-layer surgical masks are provided.

❗️INDOOR & prolonged contact are major causes of transmission. \8

ImageImage
❗️Denial of COMMUNITY TRANSMISSION, inability to discriminate efficacy of different types of masks, and wrongly analyzing exposure of healthcare workers & staffs have put workers & suspect/probable patients also at risk.

❗️Appropriate PPE gears MUST.\9

📋NATIONAL GUIDANCE TO BLOOD TRANSFUSION SERVICES IN INDIA IN LIGHT OF COVID-19 PANDEMIC by @MoHFW_INDIA.

⚠️Some critical MISINFORMATION intrinsic due to misinformed @MoHFW_INDIA policies (Clinical Management Protocol) and outdated @WHO's guide on March 20, 2020,
see 👇.\10 Image
⚠️Following negligence puts NBTC health workers, donors, recipients at risk.
❗️Droplets from exhalation may travel > 1.5 meters.
❗️INDOOR & prolonged contact major sources of transmission.
❗️COMMUNITY TRANSMISSION is ON in many parts of India. \11
Image
❗️Areas w/ COMMUNITY TRANSMISSION deferred from blood collection. Which areas in India are under community transmission? SAFETY PROTOCOLS depend on it.
❗️N95 masks & face shields are important. 3-layer surgical masks NOT efficient against COVID19. \12 ImageImage
Everyone constituting #COVID19 Task Force headed by @PMOIndia should have been informed by @ICMRDELHI when they got information from Healthcare workers of lack of proper PPE gears (survey b/n May 8-23, 2020).



ICMR paper: \13 Image
Mental health assessment of COVID-19 patient in health care & community settings depends on level & stage of epidemic a region is in.

Very crucial for post-infected patients & their families. Affect not binary: death/alive, serious injuries possible.👇

ImageImage

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More from @das_seed

सिद्धार्थ Profile picture
13 Jul
Restricted Use of #Itolizumab for CRS in moderate to severe ARDS patients due to #COVID19. No peer-review.

❗️Phase III clinical trial exempted, to go for Phase IV.

Wordings of SEC meeting & Dr Sandeep Athalye, Chief Medical Officer, Biocon Biologics, have similar tone. 👇
To understand how HUGE scientific rationale can be, check her discussion w/ @SadhguruJV, a repeat offender. She speaks on DATA as well.

Both spewed lot of misinformation & judgement that could endanger public health & lives.

How are major arguments used by @kiranshaw here not different than arguments made by @yogrishiramdev on #CORONIL? Both playing on emotions like "made in India", "used since ages", "rigorous clinical trials not so relevant in pandemic". @CDSCO_INDIA_INF

Read 31 tweets
सिद्धार्थ Profile picture
10 Jul
🚩What is community transmission? Is India under community transmission?
⚠️What are implications of community transmission? Why is @MoHFW_INDIA denying it?
🧐What are possible consequences if there's declaration of community transmission? How will it help public? (thread)\1
@WHO's definition of community transmission allows govts to announce/deny community transmission based on their agenda. Maybe vague but @MoHFW_INDIA is NOT in position to defend its denial. "COMMUNITY TRANSMISSION" is officially used in @MoHFW_INDIA's critical policy/rules. \2
March 23 by 1800 IST, 2020, we officially had 433 COVID-19 cases, 7 deaths, 402 active. @PMOIndia declares nationwide strict lockdown for ~2 months. Only few places officially had local transmission on. Today, 25 states/UTs have 500+ active cases each. \3
Read 15 tweets
सिद्धार्थ Profile picture
6 Jul
🚩Unprecedented time demands pertinent questions.

IMO, we are often not asking questions appropriate to priority.

e.g.,

1. Ask about quality, quantity, delivery status of medical devices (PPE, N95 masks, ventilators, sanitizers, etc.). NOT price even if its via #PMCARES. \1
Lives are getting lost due to delay, low quality, shortage while disease keeps spreading. You need to save healthcare workers else who will take care of patients even if we keep adding beds.

Money NOT an issue, have $2250 million loan from World Bank+ AIIB alone for COVID18.\2
Need obsession w/ saving lives & economy of country. We can ask about #PMCARES even later, but can lives lost due to shortage/quality/delay be brought back? No. Your question should determine your priority goal.

❗️allocation ≠ transaction.

Need patience for balance-check.\3
Read 5 tweets
सिद्धार्थ Profile picture
4 Jun
⚠️Public health @ risk: Misinformation by @PMOIndia @NITIAayog @ICMRDELHI

❗️COMMUNITY TRANSMISSION on.
❗️UTTERLY LIMITED test capacity & medical facility.
❗️NO ESTIMATE FOR % ASYMPTOMATIC, not in India and not for global popn!
❗️still EARLY stage. \1
❗️PRE-SYMPTOMATIC ≠ ASYMPTOMATIC.
❗️Pre-symptomatic can be EXTREMELY contagious as symptomatic ones.
❗️ECOLOGICAL FALLACY is BLUNDER.
❗️Self-ISOLATION/QUARANTINE when suspicious of exposure to infection is MUST. \2
❗️AVERAGE w/o RANGE, CONFIDENCE INTERVAL (where relevant), and SAMPLE SIZE holds too little or NO meaning.
❗️There're LIMITS to STATISTICAL INFERENCE, which SHOULDN'T be ignored.
❗️FORGED data yields USELESS calculation w/ NO valuable inferences even if plots look PRETTY. \3
Read 4 tweets
सिद्धार्थ Profile picture
30 May
❗️What're some of India's elite COVID19 calculators (@NITIAayog, @ICMRDELHI, majority of media) getting wrong? Here are some monumental blunders in elementary analysis of numbers related to COVID19 cases in India.
Rule 1: If facts are misrepresented, analysis will be wrong! /1
1. An ecological fallacy: 1st, we keep/kept deducing about the spread of infection in India by inferring global data (avg.).
Same at level of India, focused on average rather than local level data barring few states/districts. Need extensive analysis of data at local level. \2
Examples: We haven't done surveillance test or case study in India to estimate % of asymptomatic case, avg period of incubation, estimate for how much % of popn show symptoms in which week, avg recovery period from day of symptoms onset, etc. We apply arbitrary estimation .... \3
Read 15 tweets
सिद्धार्थ Profile picture
8 May
A thread. Even tax invoices (TI) sent to Ketto by @BosonMachines (BM) look cooked up (to misuse public donations?). Boson Machines have multiple major inconsistencies in their official letter (OL), dated April 30, to Ketto. Multiple self-contradictory points by Boson Machines. \1
A/c to OL: Rate per Face Shield (FS) is INR 120/- before April 14. After April 14, the rate was reduced to INR 75/- for FS from other vendors. Changing the design and manufacturing process FS price was reduced to INR 60/-.

Why huge price variations within a few days??? \2
Maths doesn’t add up: Total sales price a/c in tax invoice is INR 1199250/- (=4000*120+5550*75+5050*60), whereas page 2 of OL yields net sales price to be INR 1214250/- (=4000*120+6550*75+4050*60). Clear indication that even tax invoices were cooked up without due diligence. \3
Read 10 tweets

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