#Thread
#Covid info for all

Everyday brings more complexity and more confusing information in public and professional domain.

Here I make an attempt to bring some clarity in my own understanding of this issue.
Basics -
In a complex, complicated, evolving, changing, poor-data situation, best policy is to stick to absolute basics to minimise harm caused by foolish intervention.

What does it mean in practical terms for Covid?
1. Focus on prevention - mask up all the time, avoid socialization and closed spaces, avoid places where you meet mask-less people.

2. Long term - lose extra weight, get blood sugar in normal range, keep other illnesses in good control. This reduces risk if you get Covid.
3. Get vaccine if possible. Keep 1 & 2 going even after vaccination.

4. If you get Covid exposure or symptoms - isolate yourself even from family if possible for 5-7 days. Get tested with dr's advice.
5. If tested positive - follow isolation, monitoring of oxygen saturation and treat only symptomatically as per medical advice.

6. If saturation drops/ 6 min walk test is positive, talk to doctor immediately.

7. DO NOT load yourself with "immunity boosters" they are fake.
8. Running after remdesivir, tocilizumab, plasma puts more people in harm's way than benefiting patient.

Have a trusted doctor to treat you.

9. Once again - focus on prevention by mask, social distancing.

10. Once again - immunity boosters are fake.

May force be with us all.
Proven therapies as of now -
1. Symptomatic treatment - paracetamol, antibiotics if indicated
2. Oxygen therapy, ventilation, prone position as advised by doctors.
3. Blood thinners, low dose steroids on medical advice.
4. Rest all on individual's medical assessment.
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More from @docbhooshan

6 May
#IMS
Indian Medical Service is doctors' demand for a long time.
As a doctor, I understand need to be NOT managed by non-medicos.

If I step back and think critically, few points emerge and we need answers for that before new system is demanded.

#thread
1. Fact - Someone needs to manage.
Due to complex nature of society, politics and modern medicine, that person has to be full time manager. Essentially unable to treat individual patients.
2. This person needs training in Public health and managing complex systems.
So all glorious clinical specialities are out of question.

3. Understanding finance is really the key. So is supply chain management !

Looking at all of this it is unlikely that basic/specialist medical training is enough for the job.
Read 7 tweets
25 Apr
#Culture
#India
#Healthcare

One of the reasons of Covid fatigue for doctors in India is "multiple consultations".

So far in entire year I have not come across EVEN ONE patient who consulted ONLY ONE doctor.
Even asymptomatic people or people with mildest of symptoms contact multiple doctors.

This is how we are.

Therefore I am totally against working for telephonic helplines. If they really audit their calls..
they will realise that most callers are calling up helpline "just to confirm" what 10 other doctors + actual treating doctor has already told them.
Read 8 tweets
23 Apr
Getting psychological help for children locally.
Indians settled in developed countries.
#Thread
Focus - mal treatement of child by a family member
Since I started practice in 2000, every year I receive 5-10 calls from Indians settled in EU, UK and north america about help for a child who is at risk from a family member (mostly father but occasionally mother too).
This involves the parent being emotionally and physically abusive towards child (almost always under 10 years of age).
These families are highly educated and well settled.

One of the parent usually has an anger issue/alcohol problem or long standing mental health issue.
Read 13 tweets
21 Apr
#Covid #healthcare
Thread

First 🌊 of Covid was pure shock for all health systems and societies.

We had little knowledge of what hit us.

People died by large number in developed nations.
By the end of first few weeks we sized up the enemy very well. We also knew that there would be more waves.

As they say in 🎾 you are only as good as your second serve.
And this turns out to be truth about health care.

After doing okayish (?luck) in first 🌊, how is India facing second wave?
What has directed our response, if we can call that?

How do we compare with the world in terms of managing second 🌊,

You are the judge and the victim.
Read 4 tweets
19 Apr
If you are worried about catching Covid while at home, you can try these simple steps to reduce your worry -

1. Use small chunks of time (15-30 min) by allocating to specific activity

2. Do not re-work plans - e.g. if you are buying grosseries once a week stay with it.
3. Stop looking for more info - avoiding crowd + closed spaces and wearing mask all the time is enough.

4. Washing hands ONCE after returning home is good enough.
5. Watch your emotions - distract yourself from worry, anger, sadness by involving in physical activity, art, music, etc.
Read 9 tweets
17 Apr
#Thread
Yesterday @EricTopol tweeted about @TheLancet publication reporting "trasmission of SARS CoV 2 mainly via airborne route"

Little did he know that his sphere of influence reaches a city called Nashik in India and pensioners living in my housing complex in Pune, India.
By midnight, i started receiving questions and worried messages from my relatives in Nashik quoting this.
"Now Covid is airborne! we are doomed" was universal concern.
Then a neighbor called in the morning with same concern. Messages on her whatsapp group predicted doom.
Everyone wanted to know - What to do next?

Some had already closed their windows and ventilator gills to protect themselves from "virus air".
This is peak summer in India, temperatures are nearing forties (Celsius).My relatives don't live in air-conditioned homes.
Read 8 tweets

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