Showing posts with label Travel. Show all posts
Showing posts with label Travel. Show all posts

Saturday, February 29, 2020

Corona Med Talks Around the Globe

Corona Med Talks Around the Globe

Dr K K Aggarwal
President CMAAO< HCFI and Past national President IMA

29th Feb 2020: JAMA:
1. The virus, which spread from a single city to a whole country in only 30 days, has 2.3% overall.

2. The age distribution shows that most of the cases (87%) occurred in patients aged 30-79 years, while 10% were in patients 29 years and younger and 3% at 80 years and older.

3. While there were 300 cases and 5 deaths with SARS before the Chinese government reported it to the World Health Organization, there were only 27 cases and no deaths with COVID-19 before it was reported to that agency.

4. A major goal, is to buy enough time for scientific research, hopefully before the disease has become too widespread.

5. Iran's COVID-19 situation continued to worsen, with 34 deaths now reported (and a case fatality rate of nearly 10%)

6. Italy's government decried an "epidemic of misinformation" and tried to reassure the public that "only 0.1% of the country is involved" in the outbreak.

7. Summer Olympics in Tokyo, scheduled to begin in late July, may be called off.

8. Japan's leaders are asking all schools in the country to close for several weeks -- to the consternation of health experts who noted that children appear to be the group least vulnerable to COVID-19.

9. Switzerland has cancelled its biggest sports event, a ski marathon that normally attracts 14,000 participants, which was to be held March 8

10. Religious pilgrims are now "temporarily" barred from Saudi Arabia, no matter where they come from.

11. Australia has contingency plans to quarantine people in stadiums and order mass vaccinations if COVID-19 becomes widespread there.

12. In China, some airlines have restored some international flights as virus spread in the country seems to be waning

13. If the disease begins to spread in communities, containment may no longer be a realistic goal and response efforts likely will need to transition to various mitigation strategies, which could include isolating ill people at home, closing schools and encouraging telework, the officials write.

Medscape: Should travelers avoid parts of the world near coronavirus hotspots?

1. The prevailing advice of national authorities is to avoid Hubei province - epicenter of an outbreak that has now infected 80,000 people worldwide - and to reduce Chinese travel to the bare minimum.

2. Once inside China, Swiss travelers for example are urged by their government to avoid large gatherings and "cough or sneeze into a tissue, or use the crook of your arm." France tells its nationals not to eat raw meat or visit animal markets. The Spanish Foreign Ministry also urges against contact with animals in China and suggests making sure that you stay at least one metre away from the next person.

3. For travelers to Italy - the Dutch government recommends that its citizens avoid areas already locked down by local authorities and only travel to parts of the wider Lombardy region around the closed-off towns if necessary. The Finnish Foreign Ministry advice on Italy is simply to "take special care."

Differences also emerge in the advice to travelers on their return from an affected area.

Germany's main authority for infectious diseases tells those returning with symptoms from outbreak regions in Italy to see a doctor and call prior to their visit. But France asks such people not to visit the doctor but to call emergency services.

Britain urges its nationals to "self-isolate" at home if they have been to the areas quarantined by Italy whether or not they have symptoms. The Danish Health Authority currently stipulates no routine quarantine or isolation of people who have travelled to China or other places hit by the outbreak.

4. Turkey advises against all but essential travel to China but has not yet issued travel advice on Italy.

5. Nigeria has a voluntary two-week self-quarantine in place for all passengers arriving from China or any country with "a major outbreak." Guidance for returning air passengers says "try to avoid" going out but wear a mask if you do.


Thursday, February 27, 2020

Should I Cancel my Travel Because of the Coronavirus?


Should I Cancel my Travel Because of the Coronavirus?

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


In late January CDC issued a level 3 travel warning, recommending that anyone with nonessential travel plans to mainland China avoid going there.  But while the outbreak of COVID-19, is now spilling out into other countries as well. Now we have more new cases outside China than in China.

South Korea, Italy, and Iran have all recently reported large clusters of cases, locally spread from person to person. And we’re now starting to see cases in places near these countries. As on today there are over 82,000 documented cases of COVID-19 worldwide, across 48 countries, with over 2,800 deaths.

On 25th February  the number of new cases reported outside China exceeded the number of new cases in China for the first time. The UN health agency put the number of new cases in China at 411 on Tuesday and those registered outside the country stood at 427.

On 24th February CDC issued another round of travel warnings, with a level 3 alert for South Korea  and a level 2 alert for people traveling to Italy, Iran, and Japan.

Older adults and those with chronic medical conditions should consider postponing nonessential travel, to Italy, Iran, and Japan, the level 2 advisory states, while anyone recently returned from these countries in the past two weeks who’s developed fever, cough, or difficulty breathing should seek medical help and tell their doctor about their recent travel.

Unless the CDC issues a travel advisory for the area you are planning to visit, there is no reason to cancel any plans at this time.  But you should in general follow a good hygiene during travel. Avoid touching your face with your hands, avoid close contact with people who are sick, and wash your hands correctly and frequently—with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains at 60 percent to 95 percent alcohol.

World Health Organization advises against implementing travel restrictions in general during an outbreak, including during this one.

Those who are against the travel restriction do so for one, the fear and economic damage these restrictions create can unintentionally worsen the situation, making countries more reluctant to report cases within their own borders. They can also make people prejudiced toward the residents of affected countries or of their neighbours who hail from there.

By the time an outbreak is visibly spreading, travel restrictions may not help stop it—at most, they might buy a country some time. There is “limited research to support the use of travel bans to minimize the spread” of MERS, SARS, Ebola, and Zika, four other infectious diseases that have caused large outbreaks in recent years, with SARS and MERS being caused by coronaviruses, too.

At a certain point, it becomes less about trying to stop an outbreak from entering a country and more about doing what we can to mitigate the damage it causes, goals that tend to require different strategies.

Earlier today, CDC officials warned that the spread of COVID-19 in the U.S. is almost certainly inevitable.

On Monday, the World Health Organization declined to declare the outbreak a pandemic for now, noting that some countries seem to have been able to stop the local spread of the disease.

Singapore charges man with coronavirus for lying: A Chinese man infected with coronavirus and his wife have been charged in Singapore for lying to health authorities investigating whether they had passed the illness to others. The couple faces a fine of up to $7,150 and six-month imprisonment if convicted.





Tuesday, February 25, 2020

International Travel during Corona Period: CMAAO Guidelines

International Travel during Corona Period: CMAAO Guidelines

Dr K K Aggarwal
President CMAAO, HCFI AND Past National President IMA

The present diamond princess ship with corona outbreak has shown us to revisit our travel checklist when visiting any country

Travel advisory are of four types

Level 1 in all countries (Exercise normal standard hygiene precautions)

Level 2 in all affected countries (Exercise a high degree of caution)

Level 3 in all countries with secondary cases (Reconsider your need to travel)

Level 4 in affected parts of China and Korea (Do not travel) 

1. Keep the possibility of being quarantined for 14 days in any country.

2. Carry atleast 20 days extra essential medicines stock.

3. Always keep the passport, kept in a plastic pouch, in a safew front pocket, with you in case you need to leave the country in emergency.

4. Always carry your medicines authentic prescription with you with generic names of the drugs.

5. Always carry some dry fruits with you.

6. Always book a refundable air ticket even if they are 10% costlier.

7. Always carry a photocopy of passport and visa.

8. Always get travel insurance. Remember most standard policies won't cover you for 'Do not travel' destinations.

9. Understand that you could die. Make sure you have an up-to-date will, an enduring power of attorney. Designate appropriate insurance beneficiaries.

10. Never travel to countries with level 4 warnings ( do not travel) like for Wuhan in China.

11. For level 3 warning (like currently India for Singapore), travel only if must, minimise time spent in airports by scheduling direct flights if possible. Avoid stopovers in high-risk airports.  Stay as short a time as possible. Eliminate unnecessary activities.

12. Leave an area at the first sign of unrest, or if you feel uneasy.



Saturday, February 1, 2020

Safest place to sit in a plane in view of corona threat


Safest place to sit in a plane in view of corona threat

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


1.    All previous coronaviruses have transmitted through droplets

2.    So, it would be unusual if this new pathogen was different.

3.    The new coronavirus is behaving much like SARS

4.    Both are zoonotic, started in animals before jumping to humans, and both appear to have started in bats.

5.    The pair also transmit from human to human and have a long incubation period—up to 14 days for the Wuhan coronavirus, compared to about two for influenza—which means that people might be sick and transmitting the disease before symptoms show up.

6.     Follow CDC guidance for infectious diseases when you’re on an airplane: Washing your hands with regular soap or using an alcohol-based hand sanitizer after touching any surface—especially since there’s evidence that coronaviruses last longer on surfaces than other illnesses, around three to 12 hours. You should also avoid touching your face and contact with coughing passengers by whatever means possible.

7.     When an infected person coughs or sneezes, they shed droplets of saliva, mucus, or other bodily fluids. If any of those droplets fall on a person or if you touch them and then, say, touch your face you can become infected as well. These droplets are not affected by air flowing through a space, but instead fall close to where they originate.

8.     The hospital’s guidelines for influenza define exposure as being within six feet of an infected person for 10 minutes or longer.

9.     Respiratory illnesses can also be spread through the surfaces upon which the droplets land, like airplane seats and tray tables.

10.  Respiratory viruses can be transmitted through the air in tiny, dry particles known as aerosols. But, it’s not the major mechanism of transmission. Viruses would rather be moist, and many fades from being infectious if left dry for too long.

11. The WHO defines contact with an infected person as being seated within two rows of one another. But people don’t just sit during flights, particularly ones lasting longer than a few hours. They visit the bathroom, stretch their legs, and grab items from the overhead bins.  38 percent of passengers leave their seats once and 24 percent more than once. Another 38 percent of people stay in their seats throughout the entire flight.

12.  The passengers are least likely to get up were in window seats: only 43 percent moved around as opposed to 80 percent of people seated on the aisle. Window seat passengers have far fewer close encounters than people in other seats, averaging 12 contacts compared to the 58 and 64 respective contacts for passengers in middle and aisle seats.

13.  Choosing a window seat and staying put clearly lowers your likelihood of encountering an infectious disease.

14.  Passengers in middle and aisle seats—even those that are within the WHO’s two-seat range also have a low probability of getting infected. Because most contact people have on airplanes is relatively short.

15.  But if the crew member is infected as they spend much more time walking down the aisle and interacting with passengers, they are more likely to have additional—and longer—close encounters.

16. A sick crew member has a probability of infecting 4.6 passengers; thus it is imperative that flight attendants not fly when they are ill.
What’s worse, the coronavirus or influenza?
The reproduction number—R0 or “r naught”—simply refers to the number of additional people that an infected person typically makes sick. Transmissibility rate for the new coronavirus ranging from 2.0 to 3.1 people. That’s higher than influenza—1.3 to 1.8—but like SARS, which has a basic reproduction number in the 2 to 4 range. So, coronaviruses are slightly more prone to spreading between people.
The case-fatality ratio—or death-to-case ratio—is the number of people killed by disease divided by the number of people who catch it. Seasonal influenza, despite being considered a global scourge, technically kills a relatively small proportion of its cases, with a case-fatality ratio around 0.1 percent.
SARS had a case-fatality rate of 10 percent and the rate for the new coronavirus is currently near 3 percent, which is on par with the 1918 Spanish influenza pandemic.
Unlike with influenza, the entire human population is susceptible to this coronavirus because no one has ever had it before—and there is no specific treatment like a vaccine.

Public are dependent on infection control, such as washing hands, reducing contact with afflicted individuals and quarantines.


Tuesday, August 16, 2011

HCFI Update: Travel more than doubles risk of blood clots


Long distance travelers should periodically move around and stretch their legs, and drink plenty of water to stay hydrated, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Long–distance travel can lead to fatal blood clots in the lungs. Cancer patients, people who have recently had major surgery such as a joint replacement, and women on birth control pills are especially at higher risk.

In general, travel is associated with a nearly three-fold increase in the risk of vein clots. If such a clot dislodges and travels to the lungs, it can cause a potentially fatal condition called pulmonary embolism or a lung attack.
A combination of factors including dehydration and hours of sitting in cramped conditions explains why some people develop blood clots.

A review, published in the Annals of Internal Medicine, analyzed 14 studies involving more than 4,000 cases of venous thromboembolism and found that travelers had a nearly three-fold higher risk of blood clots than non–travelers. The risk climbed along with the duration of the trip, rising 18 percent for every two hours of any type of travel, and by 26 percent for every two hours of air travel.

Symptoms of a blood clot in the leg include pain, warmth, swelling and redness in the limb. If the clot travels to the lungs, it may cause sudden shortness of breath, chest pain or a cough that produces blood.

Some medical conditions and medications increase a person's risk of developing a blood clot. These conditions are pregnancy, obesity, smoking, heart failure, previous vein clots or clots in the lungs, advanced age, some cancers, nephrotic syndrome and drugs like birth control pills, hormone replacement therapy, erythropoietin, tamoxifen, thalidomide. The risk of a blood clot is further increased in people who use one of these drugs and smoke or are overweight.

Tips to prevent development of leg clots while on board with flights longer than 6 to 8 hours

1. Stand up and walk around every 1 to 2 hours.
2. Do not smoke prior to travel.
3. Wear loose-fitting, comfortable clothing.
4. Prefer bulkhead or emergency row seating.
5. Periodically flex and extend the ankles and knees.
6. Do not cross the legs.
7. While seated change positions frequently.
8. Avoid dehydration by drinking plenty of non-alcoholic beverages.
9. Wear knee-high compression stockings.
10. Avoid sedatives and sleeping pills and alcohol, which could impair the ability to get up and move around.