Monday, March 30, 2020



Dr K K Aggarwal
President CMAAO, HCFI and Past National President CMAAO

Media reports claim 40 crore Indians will contract coronavirus, falsely attribute it to John Hopkins university

COVID 19 recovered patient can donate blood
No. There are no guidelines available. Some centers say three months. But if he or she wants to donate plasma for serious COVID infected cases can do right away.

Avoid blood donation in COVID 19 situation
No. Most blood banks have introduced a 28-day donation postponement for donors returning from any overseas country following updated public health advice from government that anyone who returns from overseas is considered to have returned from a high or moderate risk country and should practice social distancing outside of work.
A 28-day postponement is in place for any donors who have been in contact with a confirmed case of coronavirus. This means that if you have been in contact with someone who has had coronavirus and was infectious at the time then you’ll be unable to donate for 28 days.
If you have had coronavirus yourself you will not be able to donate for three months after your recovery.
In the past, people with a mild runny nose with no fever have been allowed to donate plasma. Blood banks follow this that  anyone with minor cold-like symptoms will be deferred until they are recovered.

Coronavirus can transmit by Blood Donation
No. Since the outbreak of coronavirus disease (COVID-19) in the United States earlier this year, the AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism, in coordination with the country’s blood collection establishments, has been monitoring the evolving public health situation and preparing for potential further spread
According to the US FDA there have been no reported or suspected cases of transfusion-transmitted COVID-19. No cases of transfusion-transmission were ever reported for the other two coronaviruses that emerged during the past two decades (SARS and MERS-CoV).
Individuals are not at risk of contracting COVID-19 through the blood donation process or via a blood transfusion, since respiratory viruses are generally not known to be transmitted by donation or transfusion.

Air ambulances are not safe

Just because Philippines plane crashed does not mean air ambulances are not safe. : A plane used as an air ambulance to fight the coronavirus outbreak burst into flames as it took off from Manila’s airport for Japan on Sunday night, killing all eight people aboard, including medical workers.

R0 estimate higher in healthcare or long-term care facilities?
 There is no evidence as yet

Health-care workers can be prevented

Healthcare worker illnesses (over 1,000 ) demonstrates human-to human transmission despite isolation, PPE, and infection control. [(U) Schnirring, L., New coronavirus infects health workers, spreads to Korea.

There is no difference between porous and non-porous material as far as covid 19 infection is concerned

Porous hospital materials, including paper and cotton cloth, maintain infectious SARS-CoV for a shorter time than non-porous material. [(U) Lai, M. Y.; Cheng, P. K.; Lim, W. W., Survival of severe acute respiratory syndrome coronavirus. Clinical Infectious Diseases 2005, 41 (7), e67-e71.]

The reduction in CFR through time is an indication of better treatment, less overcrowding, or both
We have no answer as on today

Tests can not be false positive or negative

False positive/negative rates for tests are not known.



Dr K K Aggarwal
President CMAAO, HCFI and Past National President CMAAO

You can drink sanitiser alcohol

Isopropyl alcohol is commonly ingested intentionally (either as an ethanol substitute or for self-harm) or in accidental exposures. It is commonly used as a disinfectant, antifreeze, and solvent, and typically comprises 70 percent of "rubbing alcohol." When ingested, isopropyl alcohol functions primarily as a central nervous system (CNS) inebriant and depressant, and its toxicity and treatment resemble that of ethanol. A summary table to facilitate emergent management is provided
The hallmark of isopropyl alcohol metabolism is a marked ketonemia and ketonuria in the absence of metabolic acidosis.

Isopropyl alcohol is rapidly and completely absorbed following oral ingestion.

200 ml can be the toxic dose and less if the patient is on anti-depressants

COVID 19 cannot be air borne

WHO: In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures that generate aerosols are performed (i.e. endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation). In analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported.6
Like SARS COVID 19 can travel through feco-oral root
WHO: NO.? There is some evidence that COVID-19 infection may lead to intestinal infection and be present in faeces. However, to date only one study has cultured the COVID-19 virus from a single stool specimen.There have been no reports of faecal−oral transmission of the COVID-19 virus to date.

In hospitals virus can infect up to 3 hours
WHO: No, A recent publication in the New England Journal of Medicine has evaluated virus persistence of the COVID-19 virus.9 In this experimental study, aerosols were generated using a three-jet Collison nebulizer and fed into a Goldberg drum under controlled laboratory conditions. This is a high-powered machine that does not reflect normal human cough conditions. Further, the finding of COVID-19 virus in aerosol particles up to 3 hours does not reflect a clinical setting in which aerosol-generating procedures are performed—that is, this was an experimentally induced aerosol-generating procedure.

WHO has no final recommendation

WHO continues to emphasize the utmost importance of frequent hand hygiene, respiratory etiquette, and environmental cleaning and disinfection, as well as the importance of maintaining physical distances and avoidance of close, unprotected contact with people with fever or respiratory symptoms.

The R0 is an intrinsic feature of the virus.
The pandemic appears to be largely driven by direct, human-to-human transmission. That is why public health officials have told people to engage in social distancing, a simple but effective way to drive down virus’s reproductive number — known as R0, pronounced “R naught.” That is the average number of new infections generated by each infected person.

The R0 is not an intrinsic feature of the virus. It can be lowered through containment, mitigation and ultimately “herd immunity,”

For the epidemic to begin to end, the reproduction rate has to drop below 1.
In the early days in China, before the government imposed extreme travel restrictions in Wuhan and nearby areas, and before everyone realized exactly how bad the epidemic might be, the R0 was 2.38, according to a study published in the journal Science. That is a highly contagious disease.

But on Jan. 23, China imposed extreme travel restrictions and soon put hundreds of millions of people into some form of lockdown as authorities aggressively limited social contact. The R0 plummeted below 1, and the epidemic has been throttled in China, at least for now.

The virus does have an innate infectivity, based on how it binds to receptors in cells in the respiratory tract and then takes over the machinery of those cells to make copies of itself. But its ability to spread depends also on the vulnerability of the human population, including the density of the community.

If you have a seriously infectious virus and you’re sitting by yourself in a room, the R naught is zero. You can’t give it to anybody. This is also the basis of lock down.

Aerial spraying should work

There is no way to combat the virus through aerial spraying, dousing the public drinking water with a potion or simply hoping that it will magically go away.

We have not been able to trace patient zero
A shrimp seller at the wet market in the Chinese city of Wuhan believed to be the centre of the coronavirus pandemic, may be the first person to have tested positive for the disease.

The report by the London-based Metro newspaper said that 57-year-old woman, named by the Wall Street Journal as Wei Guixian, was selling shrimp at the Huanan Seafood Market when she developed what she thought was a cold last December.

Chinese digital news outlet, The Paper has said that she may be 'patient zero'.

Knowing viral load has no significance

In The Lancet Infectious Diseases
Although the authors make a case for COVID-19 presenting as three distinct clinical patterns, we believe a distinction based on such small numbers is highly speculative. Nevertheless, based on the assumption that viral RNA load correlates with high levels of viral replication, there are important insights to be gained from this time-course analysis.

Currently, our understanding of the relationship between viral RNA load kinetics and disease severity in patients with COVID-19 remains fragmented. Zou and colleagues reported that patients with COVID-19 with more severe disease requiring intensive care unit admission had high viral RNA loads at 10 days and beyond, after symptom onset.

By contrast, Lescure and colleagues report the viral RNA kinetics of two patients who developed late respiratory deterioration despite the disappearance of nasopharyngeal viral RNA. It would be interesting to know whether viral RNA load in lung tissue, or a surrogate sample such as tracheal aspirate, mirrors the decline in nasopharyngeal shedding. Nevertheless, this observation suggests that these late, severe manifestations might be immunologically mediated and has obvious implications for the potential to use immune-modulatory therapies for this subset of patients. This finding is consistent with recent reports that corticosteroids were beneficial for acute respiratory distress syndrome, and possibly those with COVID-19.

Lescure and colleagues wisely note the implications for transmission from patients with few symptoms but high viral RNA load in the nasopharynx early in the course of disease. Individuals within the community, policy makers, and frontline health-care providers, especially general and emergency room practitioners, should be alert and prepared to manage this risk. Equally worrying is the persistently high nasopharyngeal viral RNA load, and the detection of viral RNA in blood and pleural fluid, of the older patient (aged 80 years) with severe multi-organ dysfunction.

Presence of viral RNA in specimens always correlate with viral transmissibility
No, in a ferret model of H1N1 infection, the loss of viral culture positivity but not the absence of viral RNA coincided with the end of the infectious period. In fact, real-time reverse transcriptase PCR results remained positive 6–8 days after the loss of transmissibility.

In SARS live virus was detected for 4 weeks

No, For SARS coronavirus, viral RNA is detectable in the respiratory secretions and stools of some patients after onset of illness for more than 1 month, but live virus could not be detected by culture after week 3. Lancet

Its easy to differentiate between infective and non-infective virus
Lancet:  The inability to differentiate between infective and non-infective (dead or antibody-neutralised) viruses remains a major limitation of nucleic acid detection. Despite this limitation, given the difficulties in culturing live virus from clinical specimens during a pandemic, using viral RNA load as a surrogate remains plausible for generating clinical hypotheses.

Saturday, March 28, 2020

28th March COVID 19 Update Deaths will cross 30,000 in 199 countries, Minimum 27052

28th March  COVID 19 Update Deaths will cross  30,000 in 199 countries, Minimum 27052
1st one lac in 67 days, 2nd in 11 days, 3rd in 4 days, 4th in 3 day, 5th lac  in 2.5 Days, 6 lac in 2 days

0.1% population of Italy Infected, Italy and Spain more deaths than China
5909 new cases and 919 new deaths in Italy. Highest number of new deaths since the beginning of the epidemic in Italy [source] [video]. 46 doctors have died to date (with 4 additional deaths today). 6414 health workers have tested positive [source

Dr KK Aggarwal
President Confederation of Medical Associations of Asia and Oceania

India: 727 cases as per world meter, 20 deaths ( 16, MOH)
To watch
1.     Reduction in cases starting today / 30th March in view of a Nationwide Restriction of movement on 22 and Lock on 24th Night.
2.     Reduction in pollution levels

Countries 199
Cases 596723 (5% extra if CT diagnosis is taken)
Deaths 27352
Recovered: 133355
Currently infected: 436016   
Mild: 412016 (95 %)
Serious 23523 (%%)
Likely minimum deaths (23523 + 23523  x 15 = 3529) =  27052  

Friday, March 27, 2020

Caring for TB patients in the time of Corona

Caring for TB patients in the time of Corona

Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

India continues to have the highest burden of both TB and drug-resistant TB in the world. India launched a TB Free India Campaign on March 13, 2018 at the Delhi End TB Summit and has set 2025 as the deadline of eliminating TB from the country.

Today, with much of the global focus, including resources, being shifted towards Covid-19, other diseases such as TB run the danger of being relegated to the background.

But, can we afford to do so? Not, if we are to meet the deadline, which is five years before the global target of 2030.

There are lessons to be learnt from Covid-19. Covid-19 has in a way shown us the path to control the TB burden in the country. Prevention is the key and this is what will bring us closer to our goal of making India TB-free.

Both Covid-19 and TB can have similar symptoms such as cough, fever and difficulty breathing. Do not ignore any patient with cough. The WHO recommends that tests for both conditions should be made available for individuals with respiratory symptoms.

TB is an airborne infection which spreads via droplet nuclei (< 5 µ in size) released into the air when the infected person coughs, sneezes, sings or even talks. Covid-19, though not yet known to be air-borne, spreads by large droplets (< 5 µ in size).

Open TB cases are infectious and just being within close proximity of an infected person may expose a person to the risk of acquiring the infection. The risk of disease transmission is particularly high in overcrowded conditions. Anybody could be harboring the infection and therefore could be the source of infection, which could also be Covid-19.

Measures must be put in place to limit disease transmission; protective measures such as basic infection prevention and control, hand hygiene, cough etiquette are common to both.

All household and close contacts of patients with infectious TB should be traced and tested and treated with a full course of ATT if found positive for TB. This also includes people living with HIV and other people at risk with lowered immunity or living in crowded settings. These groups are also at high risk of Covid-19. And if infected, they are at risk of developing severe disease.

Contact tracing interrupts the chain of transmission of the disease by early diagnosis of cases as well as timely and complete treatment.

All TB patients, especially active and drug-resistant cases, should be isolated or self-quarantined for 14 days.

The CDC has defined the “minimum period of isolation of the patient – pulmonary tuberculosis (also includes mediastinal, laryngeal, pleural, or miliary). Until bacteriologically negative based on three appropriately collected and processed sputum smears that are collected in eight – 24 hour intervals (one of which should be an early morning specimen), and/or until 14 days after the initiation of appropriate effective chemotherapy, provided therapy is continued as prescribed, and there is demonstration of clinical improvement (i.e., decreasing cough, reduced fever, resolving lung infiltrates, or AFB smears showing decreasing numbers of organisms.” (Available at:

Every case of TB should be notified and diligently followed up during the course of its treatment. Public awareness at grass root level must be created to the scale similar to Covid-19.

Social distancing, adopted as preventive measure for Covid-19 may interrupt treatment of TB. The government must act to ensure availability of anti-tuberculosis treatment.

TB is a treatable condition. But, any disruption in treatment can result in drug-resistant TB.

The WHO has published an information note to assist national TB programs and health personnel to urgently maintain continuity of essential services (prevention, diagnosis, treatment and care) for people affected with TB during the COVID-19 pandemic. It has cautioned that during the Covid-19 pandemic, adequate stocks of TB medicines should be provided to all patients to take home to ensure treatment completion without having to visit treatment centers unnecessarily to collect medicines.

Following this call from the WHO, the government has said that it has enough drugs to last until March 2021 and India’s TB patients will not be affected. Drugs will be issued for a month in advance so that patients have enough medicines with them even case of a lockdown (, March 24, 2020).

The government has now allowed doorstep delivery of essential medicines during the 21-day national lockdown vide a notification dated 26th March, “…in exercise of the powers conferred by Section 26B of the Drugs and Cosmetics Act, 1940 (23 of 1940), the Central Government hereby directs that in case any person holding a license in Form-20 or Form-21 under the Drugs and Cosmetics Rules, 1945 to sell, stock or exhibit or offer for sale, or distribute drugs by retail, intends to sell any drug including the drugs specified in Schedule H except narcotics, psychotropics and controlled substances as defined in the Narcotic Drugs and Psychotropic Substances Act, 1985 (61 of 1985) and the drugs as specified in Schedule H1 & Schedule X to the said rules, by retail with doorstep delivery of the drug, the licensee can sell such drugs subject to the condition that any such sale of a drug specified in Schedule H shall be based on receipt of prescription physically or through e-mail…” ( )

COVID has given the answer for winter life threatening pollution: Lock Down

COVID has given the answer for winter life threatening pollution: Lock Down

Dr K K Aggarwal, President and Dr Anil Kumar Director Environment, Heart Care Foundation of India

COVID 19 pandemic has shown scary picture in number of countries and as a preventive measure entire India has been lock down for 21 days starting from 25-03-2020.

In Delhi, lock down is from 22-03-2020 (the day of Janta Curfew) and almost no movement of people and vehicles on roads in last 5 days. This has resulted in improved air quality in Delhi. In Delhi, prominent pollutants are PM10 and PM2.5. As per Central Control Room for Air quality Management – Delhi NCR, the average values of PM10 and PM2.5 in Delhi- NCR from 21-03-2020 to 26-03-2020 are as follows:

Date: 21-03-2020 (the day before Janta curfew):
PM10 (Standard – 100 microgram per metre cube )
PM2.5 (Standard – 60 microgram per metre cube )
6:00 AM
12 Noon
6:00 PM
11: 00 PM

Date: 22-03-2020 (the day of Janta curfew):

PM10 (Standard – 100 microgram per metre cube )
PM2.5 (Standard – 60 microgram per metre cube )
6:00 AM
12 Noon
6:00 PM
11: 00 PM

Date: 23-03-2020 (starting day of Lock down):

PM10 (Standard – 100 microgram per metre cube )
PM2.5 (Standard – 60 microgram per metre cube )
6:00 AM
12 Noon
6:00 PM
11: 00 PM

Date: 24-03-2020 (Lock down continued):

PM10 (Standard – 100 microgram per metre cube )
PM2.5 (Standard – 60 microgram per metre cube )
6:00 AM
12 Noon
6:00 PM
11: 00 PM

Date: 25-03-2020 (Lock down continued):

PM10 (Standard – 100 microgram per metre cube )
PM2.5 (Standard – 60 microgram per metre cube )
6:00 AM
12 Noon
6:00 PM
11: 00 PM

Date: 26-03-2020 (Lock down continued):

PM10 (Standard – 100 microgram per metre cube )
PM2.5 (Standard – 60 microgram per metre cube )
6:00 AM
12 Noon
2:00 PM

These levels of PM10 and PM 2.5 indicate significant declined trend in values of PM10 and PM2.5 due to restriction of movement of people and vehicles on roads as well as of stoppage of all other activities causing air pollution. During complete Lock down, the air quality in Delhi-NCR is within the standards.

Further, the Air quality Index (AQI) of various Continuous Ambient Air Quality Monitoring Stations (CAAQMS), maintained by DPCC, CPCB and IMD in Delhi, on 26-03-2020 at 3:00 PM is in the range of 51 to 137 which is in the satisfactory/ moderate range.

There are six AQI categories, namely Good, Satisfactory, Moderate, Poor, Very Poor, and Severe. Each of these categories is decided based on ambient concentration values of air pollutants and their likely health impacts (known as health breakpoints). AQ sub-index and health breakpoints are evolved for eight pollutants (PM10, PM2.5, NO2, SO2, CO, O3, NH3, and Pb) for which short-term (up to 24-hours) National Ambient Air Quality Standards are prescribed.

These results indicate that such measures can be taken to control Severe condition (smog condition) of air pollution in Delhi-NCR, which is happening every year in the month of November.