Monday, 30 March 2020

''Stay Home" and follow government ''lockdown'' orders -. it is the only way to reduce coronavirus impact

India, total lockdown.shuttercock com.

Time and karma.
The PM of India  and the CM of  respective  Indian states have put the entire country under lock-down to retard the progress of Covid-19 infection on a priority basis  As you may be aware, the virus spreads in clusters and the crowded places are most vulnerable to infection.  People with diabetes or any other medical condition  experiencing poor immunity system will be easy targets. These, in turn, will spread the infection among their family members, neighbors and people whom  they contact in close proximity. Considering all the pros and cons of virus impact, on the advice of medical experts and past experinces with  the Spanish flu of 1918,  leaders world over urged their  citizens to remain at home  and  told them in no uncertain term ''Self quarantine is the only way  to retard the spread of corona virus'' that progresses exceptionally  over a period of time. World over, a section of younger people won't pay serious attention to such warnings.
 In this respect, PM Modiji already took the precaution longer before other world leaders  and in his address  to the nation  urged the citizens to follow the government orders. Despite his request and Tamil Nadu  CM's stern  warning about the impeding danger of the virus in crowded markets, in  many pockets of Tamil Nadu foolish people do not care about the  warnings. Nor have they understood the aftermath of the present  danger that has already shaken the world economy  and caused widespread unemployment.  What irks me is the  remarks on the crowds at the meat shops in many places standing  closely and busy buying  meat. Their preoccupation is more focused on eating meat to their heart's content in this hour of anxiety, distress and pain  than in the interest of their community, their children and most importantly the nation.  

Media reports carried news that PM expressed his angst  and frustration that in some states like TN and others people are not concerned about the safety of the country, the  people around them and their family members.  Their unprecedented urge to eat in a time like is quite disgusting. Even in Delhi itself, a section of people never cared about the lockdown. Countries like Italy, Spain, Iran and US are paying the prices now for their past mistakes committed  for no faults of their leaders, who patiently  kept issuing the warning  to them then and there about social-distancing and avoiding crowded gathering. The youngsters. in particular, threw the warning in the air and  now  they are either in the 14 day quarantine or facing death-like situation. Playing with one's life  and that of others is a serious matter.

 shut-down across India  coronavirus.

On the first day - March 23 of lockdowns imposed across the country,  hundreds of people were booked for violating the norms and issued warnings of arrest with jail terms up to a year if the violations continued. The number of states and Union territories that imposed the lockdowns increased to 28 on Monday with Punjab and Maharashtra, the worst-hit state with 71 confirmed Indian cases, imposing curfews.
In states like Punjab, Uttar Pradesh, Rajasthan, and Madhya Pradesh, police  warned te people through the media:  violators  were “against the society as they will not stay at home.” Police confiscated vehicles people found violating the norms in states including Haryana and Rajasthan.  Despite the barricades, Police in many states did allow people  to leave home for
genuine reasons - to visit markets to buy essential goods even as most streets wore a deserted look. The only thing is they should not crowd.

The  Australian Prime Minister Scott Morrison  while announcing on Friday Mar 13, 2020 a ban on all non-essential gatherings of over 500 people starting from Monday and urged citizens to  strictly follow the Govt. orders. 
"It is a precautionary (measure). It is getting ahead of this to ensure that we can minimize the impact on your health and (so) we can ensure with ..we can minimize the impact on your health and (so) we can ensure with confidence the ability for people to be accessing the health services that they and their families will need," he said.
With a tally  just shy of 123000 US has the highest confirmed  coronavirus cases globally. It accounted for one third of national death in New York;  700 people died according to the Johns Hopkins university. This was due to partial shut down

Sunday, 29 March 2020

People with diabetes need to be extra careful in this present novel corona virus pandemic situation!!

diabetes and corona virus.
When the Covid-19 pandemic strikes a population, it does not differentiate between  healthy individuals  and those  with a history of chronic illnesses, medical complications (like diabetes, high blood pressure).  Several medical studies put them in  a "high-risk"  and, in particular, diabetic patients are more prone to  developing infection  than others and it is important for them to take necessary precaution.  In the case of people with diabetes, their blood sugar level gets affected when the insulin production is not good enough to control the blood glucose level. They go for medication, however,  the immunity in the body loses its efficiency if the blood sugar level is not controlled.
People with high or unmanageable  blood sugar levels  experience less than normal blood flow,  and it makes it difficult for the body to  use  nutrients and  natural defenses meant to protect the body against several infections and promote healing.  People with this body condition take  a little longer than usual time to recover as well.  People with less efficient immunity  due to diabetes may be more be prone to developing  infections and chronic risks than those without diabetes. This may lead to longer hospitalization and prolonged recovery.
Keep yourself safe from covid-19 virus.

It is essential for diabetics to avoid crowded places,  mass gatherings and crowded train journey. In a pandemic situation keeping enough distance and avoiding congested and crowded areas would help them a lot. In case diabetics have covid-19 infection, keep the blood sugar level under check because any symptom can possibly flare up blood glucose levels. The extra precaution is a necessity because the  body with already  compromised immune system is susceptible to  viruses to thrive in the body amidst high blood glucose levels. The risk is for people suffering from both Type-1 and Type-2 diabetes. They need to know about  foot hygiene, hand hygiene  and proper skin care. The latter can help the patients avoid  cuts and bleeds, for they if not taken care of,  may cause  major infections that will impact blood flow. Further, such patients must  drink plenty of fluids and prevent dehydration because, if infected, it may impact the  immunity. Regular physical exercise and proper diet will keep your immunity in good nick. (For further reading


Some good lessions from the ''Spanish Flu'' of 1918 to contain novel corona virus - follow government instructions

novel corona virus, 2020
The entire Indian government administration  both at the center and state levels are trying hard to contain the covid -19 outbreak in our country, the second most populous one in the world.  This pandemic  is responsible for more than  30879 deaths world wide and in India it is 24 out of 1024 confirmed cases. Currently, the USA has become the next corona epicenter with  2227 deaths  out of 124388 confirmed cases.  The worst hit is Italy where 10234 died out of 92472 confirmed cases.  The over all situation across the world is grim  and  there is no effective vaccine to end this scourge.
A similar outbreak in 1918 -Spanish Flu is an excellent  source of many important lessons  for us and other countries. Based on the past lessons, the health department can chalk out the ways and means to minimize the impact on the population. The most crucial fact is full cooperation of the public is a necessity to save the country from the mounting crisis. As for politicians, they should put their petty politics behind and cooperate with the struggling leaders in Delhi and in  various state capitals  and work with them in tandem to care for the needs and healthcare of the bewildered people in this distress situation. 
Spanish flu, 1918
Spanish flu, 1918
The most deadly  ‘Spanish Influenza’ of 1918  that has  many parallels to the current covid-19, was observed in the early stages in military camps during WWI.  There was suppression of the outbreak by certain warring countries and it was done to keep the morale of the fighting forces high. However, Spain that remained neutral gave the correct information on the outbreak; hence the flu got its name. 
India  under the Raj bore a huge burden of death - it lost 6% of its people; the flu  killed between 17 and 18 million Indians, more than all the casualties in World War One. One Hindi  writer and poet, Suryakant Tripathi (alias  Nirala,)  who lost his wife and some family members wrote:  My family, "disappeared in the blink of an eye" ... the  Ganges river  was  "swollen with dead bodies".  There wasn't enough firewood to cremate the piles of dead bodies.
The following are the lessons that may be relevant to the present pandemic:
01. Crowded city:  The flu landed in May/June in Bombay city (then the capital of Bombay Presidency) under the direct British crown administration.
The deadly flu got into the Bombay dock  through a ship of returning soldiers  in June 1918.  The health inspector JS Turner, said, .......''it came "like a thief in the night, its onset rapid and insidious". In the present situation, according to The Times of India report,"nearly every house in Bombay has some of its inmates down with fever" and it may go up soon.
02. Crowded railways: From  Bombay  the flu  had spread through the railways to other regions in India and the second wave began in September, 1918  in southern India and  moved  along the coastline.  
03. Poor health management: The other factors were negligence on the part of the British officials, poorly equipped hospitals and lack of doctors to handle a large number of infected  cases because most of them were in the war fronts. The suffering Indian masses were left in the lurch.
04. Failed monsoon: A  failed SW monsoon made the matters worse and  created  drought and famine-like conditions. Food grains production was affected.  With poor agricultural produce, people became  underfed, emaciated  and weak; huge gathering
in the cities  enabled the rapid spread of the disease.
05. Crowded markets, mass-gathering,etc: The source of infection is commonly crowded places. Crowded big Indian cities became  main sources of  the infection.  In the present  corvid-19 context,  medical researchers have reservation about crowded markets, bazaars, malls, mass transportation like metro, trains, etc.
In  February and March 2020 Mumbai (Bombay) has the highest number of covid-19 cases in the country.
06. Return of overseas-employed Indians: In  Kerala state, the corona infection cases and deaths are showing upward trend, part of the reason is returning employees from the Gulf countries. Kerala has the largest number of people in the Gulf states. The  central govt is also screening people returning from corona-infected countries.
07. Stay at home: The newspapers in 1918 advised people  not to spend time outside and stay at home;  the same has to be followed.  

08. Personal hygiene and social-distancingTOI says the main remedy "is to go to bed and not worry". People were reminded the disease spread "mainly through human contact by means of infected secretions from the nose and mouths"   Social-distancing got the main priority then, hence  workers  never went to work in offices and factories. 
09. Avoid over-crowded places:  As suggested by TOI to avoid the flu keep  away from  congested and overcrowded places: fairs, festivals, theaters, schools, public lecture halls, cinemas, entertainment parties, crowded railway carriages etc; the risk of infection lurks in such places. The Government's lock down 
in this regard is the right step and it is essential to follow it.
10.  Good sanitation: Indians hereon must give serious consideration to sanitation at home and in public places which 
is poor across India; No dumping of trashes in public places. 
Poor sanitation  may increase  the spread of flu and risk f
Besides above,  sleeping in the open rather than in poorly ventilated rooms,  and eating  nourishing food may help us a lot.The present  pandemic is sweeping across the globe with no solution in sight and no scientists can predict when it is going to come down and what will be the death toll. The  simple lessons from the Spanish flu  of 1918  are Stay home as much as you can and avoid crowded places and most importantly social distancing is a must. It is likely that the lock down period may last beyond April 14. A reliable person deplored the fact, despite lock down, 144  promulgation and strict warnings from the health officials, lots of foolish people  still crowded in Fish market in and around Thanjavur city and other places. They not only risk their lives, but also others, their own family members and their own children.
Corona virus precautions, etc:
Spanish flu, 1918

Saturday, 28 March 2020

The ''Spanish Flu'' of 1918 got the Indians united to fight for India's freedom from the British - many interesting facts!!

Spanish Flu, 1918, India
Spanish Flu,
Coronavirus is a  global pandemic  that we are passing through to day and it has shocked the world as it has caused the  sledge hammer-like impact on the world economy,  livelihood of millions of people and  total lock down of many countries. This cumulative occurrence of miseries, pain and death is  so devastating that it is much worse than  dropping off atomic bombs in a place or two.
When India was not a free country under the British Raj in 1918, it faced the worst situation  because of the onset of  the Spanish flu in the subcontinent.  It is considered the deadliest in modern history, killing at least 50 million plus people and infecting more than 500 million across the globe. The 1918 H1N1 airborne avian virus played a critical role in altering the course of India’s history.

Can you believe the flu  that was on during the WWI, caused the  largest death  in any country in the world  about 18 million people in India?  Yet another fact is  Mahatma Gandhi, who spear-headed India’s independence, also contracted  the flu and survived the dreaded flu attack!!  When news of his illness  and his daily liquid diet spread, a local newspaper took the news to the public by writing: "Gandhi's life does not belong to him - it belongs to India."  One positive aspect is this pandemic  brought about unity among the natives  against the British who had been exploiting the Indians for more than 150 years at that point of time. 
Spread of Spanish Flu, 1918, India.
''Between 1918 and 1920, an estimated 18 million Indians lost their lives to influenza or its complications, making India the focal point of the disaster in terms of mortality. .......... but the story of how the disease ravaged the continent is relatively unknown. The 1918 flu pandemic has been called the “forgotten” pandemic, and ironically the continent that seems to have forgotten it most thoroughly is the one that bore the brunt of it''....................Laura Spinney (
novel corona virus
The Spanish Flu pandemic'' of 1918  in India helped Indians  get united to fight for freedom  from the British hegemony and the following  are interesting facts:
01. Britain forced  British India to participate in the WWI and  asked the Indians to  fight at many war fronts along with the British forces. Indians produced  many essential accessories, etc for the British military. Part of  revenue from India was spent on war efforts, not on the welfare of the natives.

02. During the Spanish  flu pandemic, the British had ignored the healthcare in the country and the medical service was in a mess. It implied racial discrimination during a crisis  situation.  After the pandemic, the British administration earned the ire of the natives. Now, people made up their mind to become untied to  fight for the

03. Laura Spinney,  author of  Pale Rider: ''The Spanish Flu of 1918 and how it changed the world'' , in an interview with Patt Morrison of the Los Angeles Times said,  “People were dying in droves and in the absence of any British doctors. The British doctors…were very often at the front as well the hole was even more glaring.

04. The massacre of innocent people at  Jallianwala Bagh, in the state of Punjab on 13 April 1919 under  Brig. Gen.  Reginald Dyer shook the conscience of the whole world. For a short period, the media news reports were censored by the British, fearing escalation of protests and riots against the British.  Military officer Dyer was let off with de-promotion and minor punishment. 

05.  Continuous repressive policies of the British and denial of freedom persisted for some period. 

06. The British Govt.'s failure to honor Indian soldiers and officials' brave  participation in the war and the sacrifices made by them in various war theaters became a subject of discussion among national leaders.

07.  Over one million Indian troops served overseas in many continents under demanding, harsh conditions;  62,000 died and another 67,000 were wounded. In total at least 74,187 Indian soldiers died during the war. No war memorials in their names or a note of appreciation on the part of Britain. 

08.  The death of millions of natives, sufferings, pains  and misery  due to flu in 1918 further made the natives furious against the colonial imperialists. 

09.  More and more people across the country took the cudgels against the unjust misrule by the Raj and allied  themselves behind INC leaders like Gandhi, Patel, and others. 

10.  Newspapers  wrote articles complaining that  the British officials in India during the pandemic were  relaxing in the  resorts on the hill stations thus pushing  the administration to leave the fate of the natives  "on the hands of providence".

 11. Yet another frustration among  Indians was the colonial authorities  paid more attention to the WWI than to the health care of the people.  This grave negligence of  indigenous health care system  had left a bad impression on the colonialist.

 12. The hospitals under the British were not well-equipped to deal with an epidemic like situation.  

13. India continued to be Britain's cash cow and a large chunk of revenue was sent to the Government coffers  in London.  A decent amount of money was not spent  by the  Raj to  equip  certain important hospitals across India to deal with the disaster or an epidemic.

14. According to Ms. Spinney, ''....there was a shortage of doctors as many were away on the war front."  When the pandemic first landed in the Bombay Presidency in June 1918, it stayed there for a while and there itself it could have been contained had the British medical fraternity  acted on time. The  shortage of doctors further aggravated the distress situation. The British failed to give severe warning to the people who used crowded railways, etc  to travel to other regions.  Mismanagement of health department and lethargic attitude of the officials angered the people.

15. NGOs, volunteers and right-minded citizens  came together and formed anti-influenza committees. They, in large number, helped the poor people in the time of pain, misery and distress.

16. ''Community services'' became a watch word among the  educated and more fortunate people in the society. For the first time people in the higher strata of the society came together for a common  cause -  to help their poorer brethren  and give them solace. The powers that be - British Bobs  had let down the natives in their time of distress.

17. The  medical emergency provided an opportunity for  certain militant groups in the north and eastern India to work for India's freedom. They were against Gandhiji's principle of non-violence
for the simple reason the wily British did not take it seriously. So, they took to violence and striking terror to damage the morale of the British officers.

''Covid-19'' pandemic is not like the ''Spanish Flu'' of 1918 and can be contained!
 As of today in India  due to coronavirus, there has been 20 deaths, 903 confirmed cases and 83 recovered. Health experts say it will go up  as days go by and we have to be more cautious than before. The govt. of India announced total lock down of  the country to retard the progress of the virus. Do not ever venture out and get mingled with a large gathering of people. Give priorities to practices as social distancing, hand-washing and proper sanitation, Glad all temples, churches and mosques are closed for public safety. Right now,  self isolation is the only solution on hand and we have go a long way to go  to get out of this present health crisis that has a tight grip on the world.

This virus is not as bad as the Spanish Virus of 1918 that took the entire world by surprise, causing a heavy toll of lives across the world.  Covid-19, having been  recently  declared  a pandemic, medical researchers point out that  we need to learn  a lot from the the deadliest flu that ever stuck the world in 1918 -the Spanish Flu.  It is a futile attempt to make a comparison between covid-19 and the Spanish flu because  there is a big gulf between their  mode of transmission. However, the bewildered  and confused research fraternity have  rediscovered the Spanish Flu of 1918  in the present covid-19.   As mentioned in my previous post on Spanish Flue, the name was a misnomer; Spain had nothing to  do with that airborne avian virus that  killed 50 to 100 million people world over. India was under the Raj and we lost about 15 million plus  people.  No specific anti-viral therapies were available during the 1918 flu and it is true today.
Today US President Don Trump  has kept  calling covid-19  a China virus and blames it on  the carelessness of Chinese virus researchers in a Wuhan lab despite protests from the Communist China.  Lack of transparency on the part of China, when  first reports of  deadly virus leak came to light in December, 2019, the arrest of a doctor who who blew the whistle on  the leak of the deadly virus, tight-lipped Chinese media, evasive explanation from the Chinese government and most importantly China's refusal to allow  US journalists to gather information on the virus leak  etc. ,- all  these  angered the western countries that are presently  very much affected by the virus. The world is in a crisis with one in 3 is in self-imposed isolation.  In India, the toll is gradually going up and the governments - both Central and  State are taking precautions carefully to handle the possible 3rd stage transmission. Already the toll in the USA had gone past 1000 as on March 26. Had the Chinese made the warning  before hand in the earliest stages, the countries world over would have taken proper precaution before it was turning into a pandemic.

The viruses that cause the Spanish flu and Covid-19 belong to two  different families. Sars-CoV-2 (which causes Covid-19), belong  to the coronavirus family. The Spanish Flu  spreads through a population at a rapid clip,  but corona has a tendency to infect in clusters.  According to Laura Spinney in a recent article in The Guardian that corona virus outbreaks can be controlled as we did with  SARS (2002 in China) and and MERES provided we take proper precaution before hand. She is of the view that  1918 scenario was different from the present one; it was  war time  and  the main theater was Europe.  Yet another underlying fact is  100 years ago, religious heads were powerful and had a  tremendous political  clout with the powers  that be. So people could not go against them.   In the Spanish city of Zamora a large no of people died in 1918 - perhaps, highest in Europe.,  part of the reason was the local bishop never obeyed the health authorities and arranged for  evening prayers in honor of St. Rocco on  nine  consecutive days, providing a suitable site for the Spanish flu to show its demonic impact on the religious gathering.  No doubt, “religion, nevertheless, had played a part” in the pandemic. 
In the recent covid-19 case, more or less similar scenario  prevailed in  South Korea where cluster of  virus seemed  to have spread via churches,  particularly through prayer masses. In the case of  Iran, that was hard hit by coronavirus,  pilgrims  defiantly licked the Fatimah Masumeh shrine in Qom.
Spanish virus, 1918.
In 1918 when India was under the British rule, unfortunately the country was drawn into war  as part of the British forces.  When the Spanish fly hit India with vengeance, it caused 10 to 20 million deaths. The primary cause was packed crowded cities,  social gathering, mass movement of people from one region to other via the railways, etc. The Bombay presidency took the maximum beating in June 1918.  The deplorable fact  is the British government that got entangled in WWI did not show one tenth of interest in stopping the spread of virus  across India as they showed in native Indians' participation in the war and supply of  many  essential  accessories  made in India for the military.
Spanish virus, 1918.
Since 1918 pandemic we have made big progress  and learned a lot about the flu and its impact on the society. Its severity and rapid spread are governed by a collective interplay of viral, host and external factors. The latter include mass gathering, mass transportation and air pollution.  The Doherty Institute's Dr. Carolien van de Sandt says,'' "Understanding these factors is vital for influenza pandemic preparedness." It is worth noting, according to Sandt,  ''Climate changes affect animal reservoirs of influenza viruses and bird migration patterns. This could spread viruses to new locations and across a wider range of bird species," Different age groups, viral and host factors need to given due attention in providing emergency vaccines during future pandemics. 
We have no idea when the world will face another flu on a scale like this and it is the responsibility of the health care dept of a country to prepare its people to face an emergency situation with confidence by way of knowing what not to do, what needs to be .

done, etc. Though it is a tough proposition, virologists world over should collectively make efforts to  come up with an  effective vaccine applicable to any type of future virus(es)  primarily to control the new virus' spread and severity initially to buy time to come up with a specific vaccine to kill it based on factors such as transmission, hosts and external factors. If you want to know more about 1918 pandemic, read: Pale Rider: The Spanish Flu of 1918 and How it Changed the World. by Laura Spinney (Hardcover, 332 pages Published June 1st 2017 by Jonathan Cape. price: $12.99 Amazon) by Laura Spinney

Friday, 27 March 2020

''The Spanish Flu'' of 1918 - the most dreaded pandemic - A brief look

Spanish Flu  of 1918
An electron micrograph showing recreated 1918 influenza
Barring many facts related to mode of transmission and time of activity,  one can  see some similarity between  the Spanish Flu  of 1918 and pandemic Covid-19 that is strangling the countries across the globe  right now.  Modern analysis of Spanish flu of 1918 has shown  that the virus is particularly deadly because it triggers a ''cytokine storm'' (overreaction of the body's immune system). Because of it  20% died a very unpleasant death  and in fast-progressing cases, mortality was caused  primarily from pneumonia, by virus-induced lung consolidation. In the case of Covid-19, if the virus, once inside the human body remains there untreated,  ultimately it will reduce the efficiency of lungs causing death. It transmits in clusters and the  easy targets  are people in crowded places.
the Spanish flu, 1918
The first of two pandemics caused by the H1N1(airborne avian virus) influenza virus, the Spanish flu, the deadly one that was active from January 1918 to December 1920 infected about a quarter of the world's population at that point of  time and it left behind a trail of countless deaths, pain and sufferings, and further shattered the world economy.  The exact death toll of the Spanish Flu is a subject of debate and it is as low as 17 million people and possibly as high as 50 to may be 100 million. It is one of the  deadliest  epidemics in human history that turned the world upside down. The second deadliest one was the Swine Flu in 2009.  Much deadlier  second wave of  Spanish Flu  - 1918 pandemic  had a hold on the world for some time and those most at risk were the sick and elderly; as for  younger, healthier people, they  recovered easily. Toward 1919, the virus developed less lethal strains and cases dropped slowly.
The Spanish flu
The Spanish flu impacted many parts of the globe and since it happened during WWI,  maintaining morale among soldiers in the war front was the first priority of the warring countries.  So, World War I censors recommended minimized early reports of illness and mortality in Germany, the United Kingdom, France, and the United States.
  As for the source of the virus, in 1917 itself UK  military pathologists concerned about high mortality rate among young adults, postulated that  the overcrowded medical camps and hospitals  provided  ideal sites for transmission of a respiratory virus. The hospital treated  soldiers in tens of thousands   during the war every day.  The place was home to a piggery, and poultry  and the food supplies came from surrounding villages. The British team postulated that a significant ''precursor virus,'' harbored in birds, mutated and then migrated to pigs kept near the front. It is obvious the virus had been around for sometime even before 1918 and the military  soldiers had been carrying it without their knowledge. Later, it turned out to be a pandemic. A 2003  American medical report said that 1918 outbreak  happened in  Haskell County, Kansas. Some reports pointed that the flu first originated in China and later transmitted to other countries like the US. Chinese researchers deny  such reports.   
Given below are some important facts of Spanish Flu of 1918:
01.  The shocking fact is  Spanish flu killed more people in 24 weeks than HIV/AIDS killed in 24 years and the black death lasted for a long time.  
02.  In this  pandemic young adults were killed in large number.  
03.  During the period between 1918–1919, 99% of  deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old.
04.  Like wise death was quite common among pregnant women because the virus could weaken the respiratory system.  
05. Yet another noticeable fact is in 1918 adults above 70 had a sort of partial protection against the Spanish flu because of exposure to the Russian flu Pandemic of 1899-90. 
06. Another strange fact was this influenza was worse in winter and widespread in  the summer and autumn (in the Northern Hemisphere).
07 .The 1918 flu spread rapidly, killing 25 million people in just the first six months.
08. Over crowding, mass gathering and social contacts accelerated the spread of this influenza.
09. During the war time (WWI), troop movements, mass medical camps further triggered the spread. So, death rate can be attributed to crowding in military camps and urban environments, as well as poor nutrition and sanitation, which suffered during wartime.
10. The 1918 pandemic came to be dubbed the Spanish flu not because it originated there but because ''Spain''  remained  neutral in the war and so reported freely on the outbreak.
11. The U.S. and other countries at war   did not want the soldiers and others  to know about the  severity of the disease; reason: it might damage  their morale.
12. Some  Historians now believe  this air-bone avian virus most probably originated near Fort Riley, Kansas, in March 1918. Its place of origin is still debatable.  
13. Death in the initial wave first half of 1918 was  relatively low; highest death rate in the second wave October through December; More lethal than the first but less so than the 2nd was the third wave - spring of 1919. 
14. Most victims were certain ethnic groups who had no previous exposure to the flu. example Native American Indians. 
15.  No specific anti-viral therapies were available during the 1918 flu.

Above image: A cytokine storm is an ''overproduction of immune cells and their activating compounds (cytokines), which, in a flu infection, is often associated with a surge of activated immune cells into the lungs. The resulting lung inflammation and fluid buildup can lead to respiratory distress and can be contaminated by a secondary bacterial pneumonia -- often enhancing the mortality in patients''..(
Normally, most influenza outbreaks disproportionately kill the very young and the very old, with a higher survival rate for those in between,  But, the  chilling fact about  the Spanish flu is it caused higher mortality rate than projected among young adults.  Medical researchers came up  with possible explanations for the high mortality rate among young adults in the 1918 pandemic. Some were of the view the virus turned deadly because  it triggered  a cytokine storm. (see the image above).
 However, a 2007 analysis of medical  reports on the early pandemic published in medical   journals from the active period observed that   the viral infection was no more aggressive than previous influenza strains.The influencing factors in this case  were  undernourishment, overcrowded medical camps and hospitals, and poor hygiene. They caused bacterial super infection that resulted in the  death of most of the victims, typically after a somewhat prolonged death bed.
In the past decades various studies have been undertaken as to the  total death toll of 1918 Spanish flue. A 1991 estimate says the pandemic killed 25–39 million people. However, a 2005 estimate put death toll at probably 50 million (less than 3% of the global population), and possibly as high as 100 million (more than 5%). A clear estimate is not yet available.   As for India that was ruled by the Raj 12-17 million people died ( about 5% of the population).  The death toll in India's British-ruled districts was 13.88 million About China, the estimates are at variance and on an average it was more than 1.5 million people.
How did the Spanish flu spread?   From which country the flu had begun to spread  still remains controversial. However, based on data from Austrian archives  scientist mentioned that the influenza began to spread from Austria in 1917. The British researchers

believe that it began in the USA in 1918  The transmission of this virus was a quick one. If  an infected person sneezes or coughs, more than half a million virus particles  are out in the air invisible and can catch those nearby.  This dangerous flu became a pandemic soon because of increased mutation, easy transmission  through  close social  contact, mass gathering,  massive troop movements of World War I, crowded medical camps, hospitals, etc.  The viral became lethal during the war time as the hosts - soldiers, it is speculated, burdened by stress of  facing enemy lines and chemical attacks  and mal-nourishment. The sustained virus weakened their immunity system and made them   susceptible to diseases.Yet another important factor that promoted transmission  of virus in many parts of the globe was  travel.  With better development of  modern transportation systems in air, sea land, etc the soldiers, sailors, and civilian  had easy access to them and they became carriers of  the disease.
The following are the casualty reports in other countries: Iran: High mortality rat;  about  between 902,400 and 2,431,000, or 8% to 22% of the total population died Japan: 23 million people were affected,  at least 390,000  died; The Dutch East Indies (now Indonesia): about 1.5 million death a population of  30 million people;    USA:  About 28% of the population of 105 million became infected, and 500,000 to 675,000 died (0.48 to 0.64 percent of the population); death was widespread among native American Indians. Entire Inuit and Alaskan Native village communities died in Alaska; Canada: 50,000 died; Brazil: 300,000 died,
We in India, like other countries,  are going through a tough time, a period of uncertainty, anxiety and weakened economy  and the present total lock down, it is likely,  may go beyond April 14.  We, as responsible citizens, must obey the orders of state and central governments and trust the precautionary measures being taken by them. In the present context, with no proper medication available  for corona virus, only precaution is social distancing and self-imposed isolation   Try to shun lousy politicians who make capital out of Corona virus pandemic for their publicity. Our administrators have to tackle many problems on many fronts. For them and the medical fraternity it is a horrendous time  to be on duty beyond their capacity.  Let us all pray  and follow the govt. regulations with patience to tackle  the present emergency. Positively, we will see a silver line in the cloud in the near future.

Thursday, 26 March 2020

''Ibuprofen'' - avoid overdose of this painkiller.
Ibuprofen is a popular and  effective pain reliever in the western countries and also in India. But the awareness about this medication's bad side effects among Indian patients  is  a matter of concern and it is not satisfying. My experience has been that many doctors are  not frank with their patients about the lurking ill-effects of Ibuprofen  on us. Many of the illiterate patients do not question the doctors about the drugs being taken by them.  Nor do the doctors, on their own,  come forward and give them the correct information on the medication.  It is often reported in many scientific journals that  taking too much of it can cause serious side effects. This is true in both the short- and the long-term.
Ibuprofen risk factors.
Ibuprofen, a non steroidal anti-inflammatory drug (NSAID) is recommended by physicians to treat pain, fever, and inflammation. Hence, it is believed to be one of the most used medications in the world.   A small overdose can cause minor symptoms and in rare cases, overdoses can be fatal.  If a person  takes too much ibuprofen,  he or she should consult the hospital immediately.

Advil and Motrin are the brand names of the drug ibuprofen. Normally, people can buy
ibuprofen with lower strengths over the counter,  however, medication with high strength is  available on prescription.  Available in  various forms - tablet, caplet, liquid gel, chewable tablet, and liquid suspension or drop formulations, it is also an ingredient in many  cold and allergy medicines. The production of Prostaglandins that play an essential role in inflammation when an injury occurs and  Ibuprofen works well by controlling it. They cause skin flushing, heat, swelling, and pain. Ibuprofen blocks their action by binding to the COX-1 and COX-2 receptors on an enzyme called prostaglandin synthase.

In the case of 
both children and adults, the right  dosage of ibuprofen is  crucial and  with minimum strength it is  a safe medication.  Pain medicines are tmost often responsible for overdoses in adults. According to one report, 29% of pain medication overdoses involved ibuprofen, making it the NSAID most commonly linked to overdose. This non steroidal  anti-inflammatory drug Ibuprofen can cause heart problem,  and increase stroke risk.  However, it effects on liver are not well known and a recent study shows that its bad effects on liver are more well-pronounced  than previously thought. (vide  study published in the Journal of Scientific  Research). This study  directed by prof. Aldrin Gomes of  univ. of California, Davis was based on the the mice that were given  a moderate amount of Ibuprofen  -roughly equal to an adult taking  400mg of this drug.

It is said that as  many as 50 percent of Americans  experience difficulty in taking  ibuprofen because they experience abdominal pain, diarrhea, or upset stomach. Stomach pain may be the result of internal bleeding of the stomach or intestines, as high levels of ibuprofen (over prolonged periods) can increase acid production within the stomach.
Stomach ulcer:  Prolonged use of this drug  may  increase the risk of developing a stomach ulcer; 15 percent of chronic users will get an ulcer. Unfortunately, many may not be aware of. Bleeding from the bowels is the most common symptom associated with stomach ulcers.
Decreasing  Kidney Function : According to the National Kidney Foundation, as many as 3 to 5 percent of new cases of chronic kidney failure each year may be caused by the overuse of ibuprofen and acetaminophen.  High dosages may have a harmful effect on kidney tissue and structures. .
Breathing problems:  Prolonged use of ibuprofen may cause respiratory depression (slow or difficult breathing) to occur, which may lead to wheezing or coughing.

Drowsiness and Blurred Vision:  Too much medication means vision problems,  blurred or double vision causes dizziness and can interfere with the ability to walk.
The New Indian Express (Tiruchi edition) dated:  16 March, 2020; page: 16 --''Ibuprofen  affecta liver enzymes''.