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DR JAGADISH J HIREMATH

19 May, 9 tweets, 2 min read

Lessons learnt this Pandemic

A country like US which spends 10% of GDP on healthcare could not manage the pandemic

Whereas NZ & Australia did a good job. It helped that they are islands & put in strict SOPs to quarantine people who tested +ve, also allowed in only after testing

Non pharmacological measures for prevention worked better than trying to find cure & vaccination. It is nightmare to manage a otherwise healthy adult struggling to breathe in ICU

60K ventilators of GOI could not save as much as what N95 mask could do but we never implemented it

How many ICU beds can a country add in a day?

How many Hotels can be converted to Covid Care Centers in a week?

Can India beat US in Healthcare Spending?

Did US win against Covid having spent so much?

We know the answers to above yet we do the same expecting different results

The solution in hand was

1) Quarantine those coming from abroad
2) Mask
3) Distancing
4) Hand hygeine
5) Not allowing crowd to gather

instead people & govts were absolutely careless about the above & when the 2nd wave hit us like a wrecking ball we went in search of health dept

Hospitals can never be built for Pandemics, the infrastructure required to cater to all can never be planned in advance.

What can be planned is spreading of the pandemic using non pharmacological measures. I am saying this because now it has reached rural hinterland

The only way we can save our rural folk is by strict enforcement of quarantine of those returning from cities outside the villages & Thaluks.

Convert schools into quarantine zones & lodge those coming from outside there. We need to follow this strictly immediately.

We need to add bed strength fast in all thaluks across India. Convert every hotel present into makeshift hospital or CCC.

Every state & major district has a body called Indian Society of Anesthesiologists (ISA) & IMA. Govt of India should give up EGO & approach them for help.

Ask the local body president of ISA to coordinate for management of bad patients & in shifting them to higher centers.

The Indian Nurses Association should join hands & help in delivering care to maximum number of patients.

This is the only way ahead now in rural areas

Get Doctor & Nurses Associations to help

Stop talking to us from a high perch. You might be a minister & a powerful person in your state or in GOI but you cannot save people by dictating on those who work on the ground. Ask for help & see how force multiplication will happen.

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More from @Kaalateetham

DR JAGADISH J HIREMATH

@Kaalateetham

18 May

Guidelines to prevent Mucormycosis in Covid recovery

1) Never enter damp spaces, especially if walls already has mold or mold like growth

2) If median Sr ferritin values were high during hospital stay, you are high risk as immune dysregulation is high, wear N95 mask all times

3) Cover your face with a shield & close your nose & mouth with N95 mask if you are out in the open especially dusty areas. Since dust is ubiquitous in India never come out without protection

4) Ask your doctor if you need any prophylaxis, chances are that you will not need it

5) The key to safety is "Mask", since fungal spores can be indoors, it is better to ask your doctor how long it is necessary for you to wear mask indoors too. Normally we at ACE HealthCare advise N95 mask for all patients getting discharged for 4 to 6 weeks indoors (too).

Read 4 tweets

DR JAGADISH J HIREMATH

@Kaalateetham

17 Apr

So many assumptions & confusion

The solution is simple

1) Covid Appropriate Behaviour

2) Vaccination

The question is about those who already are positive now & are suffering the illness.

Solution:

1) 81% do not require hospital visit

2) 14% require oxygen only

3) 5% require additional care

In that 5% only 1% require ICU care, NIV, HFNC, Ventilator & other organ failure care

Remedisvir or Tocilucimab or plasma have not produced consistent results. At best Class 2b indication for usage

However, the hype has allowed few including companies to profiteer.

To date only Oxygen is Class 1 & Steroids are Class 1 or 2 indication for use in patients

Read 4 tweets

DR JAGADISH J HIREMATH

@Kaalateetham

2 Apr

@syndicatebank

Normally nobody likes to talk about their home loans; they are personal.

Decided to talk about ours. Those taking home loans need to be very careful with banks as they overcharge you while you go on with your life.

In our case @syndicatebank & @canarabank are the culprit banks.

@syndicatebank

Ours is a high value home loan by any normal Indian standards. @syndicatebank treated it like one when we were given the home construction loan through their Syndnivas scheme.

It was sanctioned in 2015 at 10.5% floating rate of interest. In time @RBI reduced interest rates

By the time we actually used the loan rates had come down to 9.5%, so far so good. However, once the money was availed surprisingly the rate got fixed & never came down!

On our part we shifted out of TN to Bangalore in mid 2017 & requested the bank to shift our loan to Bluru too

Read 11 tweets

DR JAGADISH J HIREMATH

@Kaalateetham

2 Apr

Dear friends, I have been mining to find studies which are relevant to us.

CDC has recently published one such study of 150000 subjects who suffered from #Covid

Obesity as expected is "the biggest Risk factor"

Also those patients who had very low unhealthy BMI suffered more.

BMI 23 - 25 has least morbidity & mortality
BMI 30 - 35 hospitalisation increases to 7%, ICU admissions of less than 1%
BMI > 35 associated with increased hospitalisation, ICU admissions & increased mortality.
BMI of 45+ is associated with very high ICU admissions & mortality

Also on the other hand those with BMI less than 18 had increased hospitalisation, ICU admissions & mortality.

I am certain many of us who were treating Covid patients had understood this by now. This study just shows that obesity is a big risk along with unhealthy low BMI.

Read 4 tweets

DR JAGADISH J HIREMATH

@Kaalateetham

31 Mar

Met a young guy yesterday, he had hitchhiked & trekked his way back to work from Chhattisgarh.

Came to see me b'coz he had fever & was terribly scared that I will get Corona test done on him. He was worried that his employer will throw him out of job

If you care : mask up now !

There are a lot of people who have survived the virus but are not able to survive the loss of income.

They cannot afford to lose even one day's wages. It is what keeps them "alive". They need to feed their families & it is our responsibility to ensure they are not starved.

They are not asking for charity from you or the Govt.

The money you gave to PM fund did not reach these poor people. The Govt schemes & freebies were looted by middle men. It has happened before & it will happen again.

They are only asking only for their jobs back nothing else

Read 4 tweets

DR JAGADISH J HIREMATH

@Kaalateetham

3 Feb

A 21 yr young girl came to me with severe pain abdomen. She was diagnosed with PCOD (quite common USG finding now) & taking treatment for the same.

The pain was unusually severe was associated with lot of belching by the girl. She jumped in agony when her abdomen was touched

With good history taking it was clear that she had inhaled chemicals while working in a R&D facility of a drug major. While she was told by a doctor the previous day that her problem was aggravated PCOD we did not agree with it.

Asked our Industrial Health Expert to investigate

Meanwhile her enzyme levels which indicate acute pancreatitis were all elevated, CT & USG showed inflamed edematous pancreas.

Our Industrial Health Expert came back with the report that the chemicals girl had inadvertently inhaled during work can cause pancreatitis

Read 7 tweets

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