Author: The stawa team

Studying recent studies

Posted on by The stawa team

While surfing the internet recently, I stumbled on a ‘study’ that concluded, “According to a recent study, all recent studies are false!” I could not stop laughing when I read this statement. Yet, it seems to describe the state of research in the context of the novel coronavirus. Nine months after its appearance in China and 17.8 million cases worldwide and 686,703 deaths so far (4 August, 2020), we still know very little about it. It is still a ‘novel’ coronavirus.

In fact, study results are being released every other day and a new treatment regime is being added to an already complicated treatment protocol. A vast array of drugs is currently being used to treat this virus with varying result. So far, we are using an antibiotic (azithromycin), which is meant for a bacteria (corona is a virus), an anti-viral (Remdesevir, Favipiravir), antiretroviral drugs (Lopinavir, Ritonavir) that are meant to treat the HIV virus, antihelminthic drugs (Albendazole, Ivermectin) that are meant to treat parasites, steroids (dexamethasone), anti-malarial drugs (chloroquine, hydroxychloroquine) that are meant to treat malaria, immune system boosting interferons etc. The latest addition to this list that was announced as I was writing this article is a dye called methelene blue that is used in nebulisation. All of these drugs are based on some studies. Like the now famous hydroxychloroquine, each of these drugs have been introduced as a “game changer”.

It has been a relief to have reliable and fast internet connectivity in Ladakh over the past year. The internet used to be notoriously unreliable in the past. “Is the internet working?” used to be a convenient way to start a conversation in Ladakh till fairly recently. The internet was especially helpful during the lockdown. Imagine how the lockdown would have been without the internet or an unreliable connection? It would have been rather difficult. This time around, people found solace through their smartphone and computer. Each of us has consumed a high dose of webinars and online classes over the last few months. There are several jokes online of people collapsing in front of their computer or phone from an overdose of webinars. Similarly, there have been jokes of doctors spending more time online conducting webinars as specialists on COVID-19 than actually than actually treating COVID-19 patients time in the real world. I too had to join many such webinars. While my presence was visible, I would often mute the microphone and turn the camera off. This seems to be the new way of ‘bunking’ in the online era!

A few days back, a study was carried out at the hospital where I work to check the seroprevalence of COVID-19 antibodies among staff members. We braced ourselves with the expectation that many staff members would test positive given the number of COVID-19 cases being detected and treated at the hospital. A recent study elsewhere revealed a higher load of COVID-19 infection among health workers at a non-COVID-19 facility as compared to a dedicated COVID-19 hospital largely due to the use of better PPEs at the latter. Testing positive for the antibody means that the body has developed some protection from being re-infected by the same virus. Most health workers at our hospital tested negative for COVID-19 antibodies. This meant that very few staff members had been infected by the novel coronavirus over the past month or so. It also meant that precautionary measures being taken by our staff has been effective. If these inferences are false, then there is another scarier explanation: Immunity after COVID-19 infection is uncertain if the body has not developed antibodies. This means we may get re-infected several times over while the novel coronavirus remains in circulation. A recent study says so! If true, this particular finding can be a big hindrance for vaccine development as the science of vaccination is based on intentionally triggering antibodies in the body.

There are other studies that document asymptomatic cases reporting back with heart and lung complications months after getting treated for COVID-19. Yet another study states that children carry more virus in the nasopharynx and may be more potent carriers than adults. Yet another study says less cases among children may be due to low community spread due to school closure. The fact remains that this is a new disease and we still do not know much about it. This madness of studies will continue till we start to get a clearer picture of the novel coronavirus. However, there is danger in increased knowledge too as mentioned in the famous expression, “Familiarity breeds contempt”.

This is already evident with the emergence of a group of people who are being termed as ‘covidiots’. These people remain in denial of the seriousness of the novel coronavirus. They dismiss it with arguments such as “It’s just a flu…”. many of them believe that they will get infected sooner or later and argue that it’s good to get infected. Common sense, and our knowledge of public health suggests that it is more prudent to take precautions till a safe and effective vaccine is available for everyone or the pandemic ebbs. I see the latter happening sooner as the emphasis for the vaccine is on being ‘safe’ and ‘effective’, which typically goes through five stages of development and normally takes around five to 10 years.

By Dr Spalchen Gonbo

Dr Spalchen Gonbo is a Paediatrician based in Leh.

An opportunistic virus

Posted on by The stawa team

Very few children seem to be getting infected by the new coronavirus and even fewer are actually getting sick from it. Having watched its progress through treating patients with a wide range of severity of symptoms, I have reached a fairly simple conclusion. The new coronavirus is a mean and opportunistic virus. It is like a bully that oppresses the weak and vulnerable. It’s constantly on the lookout for victims that it can overpower. It cannot harm or at least does not seem capable of harming a person with a strong constitution. A healthy person may not even realise that the virus has invaded his or her body. However, the virus uses healthy people as a way to infect others who might be weaker and more vulnerable. This is a classic trait of an opportunist! It preys and harms the weak and spares the strong. This reminds me of the Ladakhi proverb, “Nyam chung nga Shig ge tsod chad” (Even lice will bully a docile person).

I will admit that I was happy in the initial days when it was believed that children might be immune to this virus. It was seen that among all cases of this new disease, only 1% or less were below 18 years of age. This was a relief to most parents, including me. While this still seems to be true to a large extent, children have started showing a diversity of symptoms caused by novel coronavirus besides regular cough and fever.

One of our recent patients is a 14-year-old boy. It seems perhaps coronavirus was too weak to overpower him earlier or the boy was too strong for this opportunistic virus. Perhaps the virus has been lingering around him for some time but could not harm in any way. The boy probably took all precautions including wearing a mask and washing his hands frequently. And yet, he was to soon become infected by this mean virus.

The boy met with an accident when he fell from a tree while playing. The resulting injury confined him to a bed for a few weeks and weakened him. This served as an opportunity for coronavirus and it managed to overpower his otherwise strong immune system. He developed a very severe form of the disease. Think there are many lessons here for us to ensure that we are healthy, fit, and strong at all times.

However, I cannot help but wonder if the coronavirus is not worried about its own survival if it continues to harm its victims. Every creature, including humans and plants, are constantly trying to increase their population. However, nature always has system of checks and balances. For instance, human action causes a decline in bird population, which in turn results in an increase in insect population that will decrease the yield of human farms! This leads to major social, economic and environmental challenges. Nature does not favour anyone and has systems to check all forms of excesses.

So, what will happen to coronavirus? Nature will not tolerate the havoc caused by this virus. It will increase human capacity to counter this opportunistic virus by modifying our immune system by producing immunoglobins. We have seen this happen countless times in the history of all living creatures on the plant. Nature teaches us and we have to learn. Perhaps, this time we will work in sync with nature to live healthier lives and respect the environment. In turn, we will be able to develop a vaccine to help our body strengthen its defences before the virus invades it.

As of now, it the most important thing we need to do is protect high risk individuals who have a weaker immune system that makes them vulnerable to the ravages of this virus. At the same time, we all must adopt healthy lifestyle habits in terms of our diets, give up addictions (smoking, alcohol etc) exercise regularly, which will hold us in good stead even beyond the current pandemic.

As for our 14-year-old patient, he has turned out to be rather brave. He seems to be emerging from the disease through his mental and physical strength. I have witnessed him counter the bully. He is currently recuperating well and waiting for the results of his test that will tell him if the opportunistic virus has left his body.

By Dr Spalchen Gonbo

Dr Spalchen Gonbo is a Paediatrician based in Leh.

New Delhi Diary – July 2020

Posted on by The stawa team

As if COVID-19 was not enough!

Is 2020 going to be the worst-ever year, particularly for India? COVID-19, Cyclone Amphan, Cyclone Nisarga, Chinese intrusion into Ladakh and the subsequent killings of soldiers on both sides; 17 earthquakes over three months in northern India, and locusts creating havoc in Rajasthan, Madhya Pradesh and Haryana. As a result, we are now facing an unprecedented economic meltdown.

It is feared that we are in for bad days for the foreseeable future. Even then, there is a brighter side. As a friend says, having braved all these difficulties and hardships, we will learn some lessons, and be able to live a ‘better normal’. The phrase ‘better normal’ is an ‘improvement’ over the popular phrase, ‘new normal’ that has become a buzz word under these new circumstances.

And then came, as if to our rescue, Zoom, Google meet, webinars, and various other online means to ‘hold’ a ‘virtual conference’ enabling hundreds of people to talk with one another and discuss critical issues like ‘life betterment’ under stressful conditions.

Booked and hooked!

Here is a book that kept me hooked and booked, and prevented me from descending into insanity during these lingering Corona days: The Path of the Buddha: Writings on Contemporary Buddhism, edited by Renuka Singh, a former JNU professor. True, the book may not have anything new for someone who is already familiar with Buddhist philosophy, but what comes out brilliantly is the way each topic, from birth to death, karma to undoing of bad karma etc. has been dealt with by writers of eminence. It not only works as an introduction to Buddhist philosophy but also introduces one to the relevance of the need to have a ‘different-angle’ look into the mysteries of the mind and matter.

Mind and matter are, normally, two different things, and each has a tendency to ‘stay away’ from the other. But when matter, let’s say our physical body, particularly the brain, is made to look for that dynamic energy or force within us, then there is a union of mind and matter, even if for a moment of one’s consciousness!

Monsoon blessings

The city was blessed with monsoon showers a week before its scheduled time. The month of July gives the city a new and fresh appearance. It glows in the charm of lower temperature, intermittent rain, parched land turning green, and birds and other animals in their best spirit. And, we, the 1.9 crore denizens of the city, enjoy a cloud-speckled sky with promises of imminent rain and cool, refreshing air. Since Monsoon is so kind to us this time, life has become a little more comfortable. With the intense heat of May and June behind us, one tries different ways to celebrate life, and hope for the arrival of better days soon.

And yet, despite so many problems, the clouds that come and go without any ‘convincing’ reason, give one the satisfaction and the understanding that nothing is permanent and that the good and the bad in one’s life is to make one a little more careful and loving so that one doesn’t mess up with life and nature!

Inner voice vs. outer voice

People often wonder: What is our ‘inner voice’ and how does it differ from our ‘outer voice’? Until one thinks over it seriously, one can easily get lost in search of an answer. And, as a result, one might conclude that these are silly questions and that there is no point in pondering over them. And whoever has heard of this ‘outer voice’? But if we mull on these questions more seriously it does reveal many dimensions. The nearest and the most convincing answer could be this: Well, inner voice, when given an expression and accepted by others, becomes an outer voice. And, an outer voice, accepted by an individual and given an expression becomes an inner voice. Well, it is so very complex, but, my dear, philosophy is always like that!

But, in a way, the ‘inner’ and the ‘outer voice’ support each other in gaining acceptance, and for the greater good of mankind. Both help one realise one’s own self and expand one’s consciousness.

Tailpiece:

Doctor: Ma’am, good news. Your husband is COVID-19 negative.

Wife: How does that change anything? He has been a very negative person all his life.

By P. P. Wangchuk

Prejudice in the time of coronavirus

Posted on by The stawa team

A high-pressure situation generally brings out the best and worst in people. The COVID-19 pandemic is no different. It has underlined various prejudices, ignorance and visceral divisiveness amongst people around the world. While more than a million people around the world cutting across race, religion, gender, and other superficial differences have been affected by COVID-19, people have still found ways to target specific communities to blame for the pandemic.

Perhaps the most famous and public expression of prejudice was US President Donald J Trump referring to COVID-19 as ‘Chinese Virus’. This was echoed by several right-wing leaders and media-persons with such political leanings. In practice, this led to a racial backlash against persons of Chinese origin who were blamed for the pandemic.

India too has been susceptible to this trend. There are numerous cases of racial prejudice faced by Ladakhis and persons from the Northeast India, in the Indian plains. Perhaps the most common expression of this prejudice and ignorance is when people from Ladakh and India’s Northeast are being taunted with racial slurs. There were several cases of Ladakhi students being asked to vacate their rented spaces. There are numerous cases where this ignorance has taken a more unpleasant expression. There are cases of people hurling abuses, spitting and threatening physical violence against people from Ladakh, the Northeast or others with similar racial and ethnic features.

In addition, in India the Muslim community has also faced the brunt of prejudice and discrimination with many blaming members of the community for spreading the virus in the country. The COVID-19 pandemic has taken on a communal hue in India after news of the Tablighi Jamaat convention in New Delhi became public. In the midst of a generally professional approach to a pandemic, there were some disturbing news reports of some doctors refusing to treat Muslim patients because of their religion. Islamophobic memes started to appear on social media and hash-tags such as #CoronaJihad and #TablighiVirus were trending on social media.

Former Chief Minister of the erstwhile Jammu and Kashmir state, Omar Abdullah condemned the communalisation of the pandemic through a tweet on 31 March where he wrote, “Now the #TablighiJamat will become a convenient excuse for some to vilify Muslims everywhere as if we created & spread #COVID around the world.”

Many of these prejudices have been evident in Ladakh. In early March as the first cases of COVID-19 were reported in Ladakh, it emerged that the patients had returned from a pilgrimage in Iran. While there was no overt expression of discrimination, many people privately expressed their prejudices with regard to the Muslim community for bringing COVID-19 to Ladakh. People, including highly educated individuals and religious leaders, would freely cite un-verified claims circulating on social media and television to justify their prejudices.

Furthermore, migrant labourers in Ladakh were at the receiving end of prejudices as fear of COVID-19 peaked in Ladakh. Many Ladakhis were being thrown out of their rented spaces by landlords who feared contracting COVID-19 from them. Each year hundreds and thousands of migrant labourers from different parts of India and Nepal arrive in Ladakh by March; and have played a pivotal role in building Ladakh. However, this year, many of them were forced to leave their rented spaces in Leh, Changthang, Nubra, Sham and Lalok. Furthermore, landlords in two neighbourhoods of Leh asked even their Ladakhi tenants to leave and return to their villages.Such actions left many migrant labourers and Ladakhi tenants in a lurch. The district administration tried to counter these actions by warning landlords of legal action, while also providing ration and financial support to some migrants to return home. The UT Ladakh administration has also put social media group administrators on notice for the content being shared and discussed on their groups.

It is unfortunate that Ladakhis, people from the Northeast and Muslim communities have had to bear the brunt of people’s prejudice and ignorance. However, it is equally unfortunate that many people in Ladakh too acted on their prejudice, ignorance and fear to target vulnerable groups of people, especially migrant labourers and people from rural Ladakh. At a time when containing the virus should be our collective priority and when unity is a necessity, people around the world have submitted to their deeply held prejudices and fears. In contrast, coronavirus does not differentiate on the basis of race, class, caste, religion, gender, or for that matter age. We will hopefully develop a vaccine for COVID-19 and other such viruses. But how will we find a cure for the prejudices, ignorance and deep-seated hatred we seem to be nurturing within ourselves?

By Tashi Lundup and Sunetro Ghosal

Tashi Lundup and Sunetro Ghosal are part of the editorial team at Stawa.