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Control TB? End TB ? Eliminate TB ? I often find the phrases being used interchangeably. What is the right terminology to use in what context? A short thread on this topic By 2015 (reference 1990), the MDG goals for TB were achieved - to stop increase in incidence and halve the mortality. The goal was reached globally and in 16 of the 22 high-burden countries that collectively account for 80% of cases. Then came SDGs

Tweet 🧵

1/15
Screening People with Tuberculosis for High Risk of Severe Illness at Notification: Programmatic Experience from Karnataka, India mdpi.com/1151162 in journal #TMID via @MDPIOpenAccess

#OperationalResearch led by @SharathBN and me

https://twitter.com/hshewade/status/1403664059690405897

2/15
Before #COVID19, #TB was the leading infectious disease killer

People with TB r not systematically screened for severe illness @ diagnosis. Something we do in COVID19

To #EndTBDeaths, @TbDivision recommends assessment of severity @ diagnosis n referral 4 inpatient care

Rant

“Don’t criticze. Spread positivity. See how you can help others”

This statement is made with the assumption that people who criticise Governments are not helping others and people who post messages like “spread positivity” are helping others.

.. Let us learn to call a spade a spade and not get stuck in this propaganda of “spreading positivity”.

The central Govt has bungled up COVID19 vaccination despite us having the vaccines (large chunk exported) and technical expertise of running vaccination campaigns.

..

#TakeAStand

The current COVID19 pandemic in India has exposed the fact that medical and public health experts within the system do not #TakeAStand.

1/4 I am talking about basic stuff like
- Data transparency - eg interpreting low deaths in India based on low reported COVID19 deaths. Govt continue to boast about this.

2/4

1/n

Thread 🧵
India COVID19 vaccination, what we did and what we should have done?

Now that we have seen this post👇, do not how LOW is our coverage(%) of 2nd dose(fully vaccinated) among elderly / >45y

https://twitter.com/HShewade/status/1385309722736304132

2/n
Therefore with these levels of LOW coverage, we cannot expect any dent in the hospitalisations and deaths

We missed a window of opportunity during Feb/Mar

1/5
#WrongCOVIDVaccinationStrategy

All India had to do in Feb/Mar 2021 was complete both doses for >45 y in campaign mode (at least in elderly, at least in high burden districts)
That required planning in advance, procuring 40 crore doses and distributing to the states 2/5
#WrongCOVIDVaccinationStrategy

The states distribute it to districts and PHCs based on the estimated requirement in microplans.
Vaccination should have been done using our pubic health vacc system that is decentralised upto the Anganwadi through bottom up micro-planning

One tip

If a covid patient at home has a dip in oxygen levels (<94%) despite a 6 min walk test that means they need to get admitted in a covid bed with at least oxygen.

If a bed is available, public or private, get them admitted without DELAY

No If No But .....
After reaching hospital, hospital says only bed with O2 available, no ventilator

Mistake that people do this travel around looking for bed with ventilator (just in case)

My suggestion would be to get admitted if a bed with O2 is available esp in these times.

#India #WrongCOVIDVaccinationStrategy

We as Indian public, media as well as the Govt lose the plot when we start talking about absolute numbers and vaccinating entire population, at least for now

1/n For immediate reduction in hospitalisation and deaths (within 4-6 wks), we should ensure a rapid and wide coverage of COVID-19 vaccines in >45y population.

So
Ask data for coverage among these vulnerable pop.
Ask, is the current CoWin dependent strategy appropriate?

2/n

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India should urgently change its COVID-19 vaccination strategy - why and how?
@MoHFW_INDIA @NITIAayog

(1/25) Change in strategy is not as simple as making vaccination open to all (vacc criteria).
Still after 35 days of phase II, the numbers suggest that the coverage among elderly is abysmal and this needs immediate correction

(2/25)

@BWDDPH @BWDDPG @janisfrayer @pash
I watched the video with interest. I have been following the COVID-19 numbers and here is my take esp on the deaths.

To infer the extent of COVID-19 mortality in India using ‘reported’ COVID-19 deaths is not correct. Let me explain.
(1/n) @BWDDPH @janisfrayer @pash In a scenario of very high seroprevalence (20%), very low covid case detection rate (3.6%), very poor coverage and quality of routine death surveillance (18% coverage), and low % of deaths in hospitals (34%), for me the reported covid deaths are waay lower
(2/n)

I will share death registration and medical certification of cause of death coverage in India-state by state. One tweet per day.
In the absence of reliable cause of death data, how can we effectively plan to reduce cause specific deaths? (1/n) #CRS #MCCD #RoutineDeathSurveillance In India,
86% of estimated deaths are registered (CRS report 2018)
21.1% of registered deaths undergo cause of death certification (MCCD report 2018)

Therefore
18.1% (86%*21.1%) of all estimated deaths undergo registration along with cause of death certification
(2/n)