Corona Daily 452: The Doctor’s Dilemma: Part II

Hospitals are now overwhelmed. They have to let some patients die, so others may live. Most shortages are chronic. For example, more ventilators can be produced, but they need respiratory therapists and trained nurses to operate them. The therapists and nurses work in three shifts. Frontline soldiers in this war, they must remain healthy through the pandemic. Manpower is a serious limiting factor for ventilator use.

For patients and relatives, denial of access to intensive care or withdrawal of ventilator support can be traumatic. In the USA, law and lawyers are more developed than health care. Hospitals implement the health departments’ triage guidelines to protect themselves from future lawsuits.

New York Times (31 March) studied the health-care rationing strategies of ten states. I offer here the highlights from that article.

State of New York doesn’t admit people who may die despite treatment to the ICU. Patients with cardiac arrest not responding to defibrillation, or with brain injury or severe burns are excluded. Patients on ventilators are assessed every 48 and 120 hours. Ventilator support is continued only in case of improvement. If a patient’s condition worsens, the ventilator is removed.

Alabama denies ventilator support to AIDS patients, severe cases of mental retardation and children with severe neurological problems.

Washington can refuse ICU access to severe failures of the heart, lung, liver or multi-organ. Patients on the ventilator are checked once a day. If improved, they are moved out of the ICU. If the condition becomes worse, the ventilator is taken off, and end-of-life care is offered to free up space. This policy has been criticized, because in many cases the condition becomes worse before improving. Days or weeks of ventilator support can bring a patient back to life. (Boris Johnson).

Louisiana denies the ICU to patients with severe dementia.

Sequential Organ Failure Assessment (SOFA) scores patients based on the functioning of heart, lungs, kidneys, liver, blood and brain. (Here low scores are better, high scores bad). Maryland disqualifies people with higher SOFA scores. Pregnant women with a healthy foetus get a one-point credit in Maryland, two-point credit in Pennsylvania and one-or-two in Utah depending on how advanced the pregnancy is.

Between “Patient A, age 24, with a SOFA score of 13”, and “patient B, age 72, with a SOFA of 10 and mild Alzheimer’s”, Maryland will treat the older patient because he has a lower SOFA. But in Pennsylvania, moderate Alzheimer’s penalizes him, and the younger patient gets precedence.

Besides Alzheimer’s Pennsylvania is harsh on cancer patients with less than 10 years of expected survival. Premature infants with low chance of survival qualify for neither ICU nor ventilator. Pennsylvania offers one credit point to health workers.

USA’s federal civil rights office has started investigating discrimination based on disabilities, race, age or religion. Measures such as SOFA are criticized as they discriminate against the black and poor. Because of low health care access, their health is normally poorer. Currently, disproportionate numbers of blacks are dying of covid-19 in New York.

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In March, a group of ten MD/PhDs from across the world has published an excellent paper on this subject. I will discuss their recommendations tomorrow.

Ravi

Corona Daily 453: The Doctor’s Dilemma: Part I

In The Doctor’s Dilemma, a wonderful play by George Bernard Shaw, a renowned doctor Sir Colenso develops a new vaccine for tuberculosis. With a severe shortage of resources, the doctor can save only one patient. A young woman begs him to save her ailing husband. And an older man, a friend of Sir Colenso’s is also in need of the vaccine. This friend is an ordinary but good-natured man. Whereas the younger patient is a talented artist, but is a womanizer, a person without morals. In the long play, and longer preface (typical of Shaw), Shaw discusses the moral issue doctors face at times: who should live and who should die?

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Corona virus has opened up hundreds of such issues. Do governments have a right to lockdown people? And if so, for how long? Should privacy be sacrificed in the name of safety? Should we download the contact-tracing app that records our every move? Why do people hoard toilet paper? Is it right to charge higher prices for products in shortage? Is it moral for a government to stop all public transport? To close schools and lock children indoors?  Is it ethical to let online workers earn their living, without supporting the off-line workers who have lost their jobs and paychecks? Is it fair to let people in prisons be infected, as they invariably will be? Vaccines must be tested on animals extensively before humans. The urgency to develop a vaccine is tempting pharma companies and regulators to short-circuit that. Can that be ethical?  

Moral governments and ethical rulers (the few left now) ask themselves these questions, and decide their strategies accordingly.

Medical issues are the most discussed ones. What Shaw wrote is harsh reality today. In Europe, in America, and soon probably in India and most African countries.

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Triage is the process of deciding the priority among patients for treatment. In mass casualty incidents, such as the collision of two buses, paramedics and doctors urgently need to decide who should be treated first and why. Triage is common in wars where the injured and dying far outnumber the doctors and medicines available.

Most developed countries have triage protocols in place. Based on them, even in the USA, patients are now refused admission into ICUs. In many cases, in order to care for a newly arrived patient, someone else’s ventilator is removed. Patients are given colour codes (blue, red, yellow and green) to specify the treatment they will or will not receive.

Imagine six patients arriving at your hospital:  a 35 year old white man, a 57 year old black woman, a 45 year old with AIDS, a healthy and wealthy 81 year old man, an 11 year old Asian girl, and Tom Hanks. All of them require a ventilator – you have only one. While you are making your decision, a heavily pregnant woman arrives outside the ICU.

Who do you put on the ventilator?

Tomorrow, I will discuss the existing protocols that answer this question.

Ravi

Corona Daily 454: Flying to Nowhere

Forty year old Edgard Zeibat, a German, was flying from Vietnam to Turkey on 18 March. He had to transit through Delhi. On landing in Delhi, he learnt his Delhi-Istanbul flight was cancelled. Most other connections were rapidly cancelled. The airport was emptying quickly.

Edgard was not the only one. Authorities contacted the embassies of all stranded passengers. They were given airport meals, toothpaste, and to their surprise, a mosquito net. In four days time, India’s stringent lockdown began. All flights stopped. Edgard’s companions gradually disappeared. Now it was just him.

India allows visa-on-arrival. And this was a crisis time. India’s lockdown couldn’t be Edgard’s fault. He presented his passport at the visa on arrival counter.

‘Sorry Sir,’ the man checked the screen and said, ‘we can’t give you a visa.’

The German embassy had confirmed Edgard was a wanted criminal, with several cases of assault and other crimes against him. The embassy couldn’t take his custody without proper extradition procedures in place. Indian laws prevent giving known foreign criminals a visa. Edgard Zeibat has been a resident of the Delhi airport transit area for more than 50 days now.

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The longest transit lounge stay record belongs to one Mehran Karimi Nasseri. He was an Iranian who said his mother was a British nurse. His briefcase with documents was stolen, and he found himself inside the Charles de Gaulle airport in August 1988. He called himself Sir Alfred, and insisted he should be sent to Britain. He lived in Terminal One for 18 years. A corner with a red bench became his residence. His years were spent in reading newspapers, eating meals given by the airport staff or the passengers. He even studied economics. Mehran Nasseri was the inspiration for Spielberg’s well known film ‘the Terminal’.

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More recently, we have the case of Edward Snowden. In 2013, he spent 39 days at Moscow’s Sheremetyevo airport transit hall. He ended up taking asylum in Russia, where he still stays.

In the 1990s, when I lived in Russia, I would regularly see Sri Lankan refugees living at the same airport. They arrived on an Aeroflot flight from Colombo, destroyed their documents on the flight, and asked for asylum. The Russian government didn’t entertain these requests, but allowed the transit fliers to reside at the airport for long periods. I have no idea what happened to them in the end.

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Edgard Zeibat’s case is a complicated one. India will not accept him as a refugee. Extradition to Germany requires complex procedures and co-operation from Zeibat. Now that the case is published, India can’t send him to another country. Herr Zeibat seems destined for years of stay at the Delhi airport. It is modern, air-conditioned, with clean showers, a variety of restaurants, TVs, Wifi, and comfortable recliners.

Only if he indulges in criminal activities or falls ill with Covid-19, India will be entitled to do the sensible thing and transfer him to a prison or a hospital.

The story of the no-flyer has only begun.

Ravi

Corona Daily 455: Let’s Keep Fighting

On Friday, 8 May, a UN resolution was expected to usher in a new era.

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Antonio Gutteress, the UN secretary general, had proposed a global ceasefire on 23 March. The pandemic is expected to last between two and three years. While it lasts, let us focus on this common enemy by stopping all wars and conflicts.  ‘The fury of the virus illustrates the folly of war’, he said.

Surprisingly, many armed groups supported the truce proposal. By early April, fighters in twelve countries shelved their arms. They included a communist guerrilla group in Philippines, liberation armies in Columbia and Sudan. (South Sudan, the world’s newest nation, has 12 million people and 4 ventilators.) A Saudi Arabia-led coalition and the Houthi rebels declared ceasefire for two weeks.  Syria, Lebanon, Iraq, Yemen jointly appealed for a halt to all fighting in the Middle East. Currently 310 million children in the conflict zones are deprived of school meals, their main source of nutrition, due to school closures.

On 30 March, 53 countries issued a letter supporting the Global Ceasefire proposal. France was the only nuclear nation to sign it. Encouraged by the letter, Antonio Gutteress reissued an appeal on 3 April.

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Friday marked the 75^th anniversary of the end of WWII. The five victors- USA, China, Russia, UK and France formed an exclusive nuclear club. They also gave themselves veto, a power as dangerous as nuclear weapons. Thanks to that power, USA and UK allowed apartheid to continue in South Africa for 44 years, Israel’s land grabbing is protected by the USA, and Russia vetoes resolutions against Assad. These five countries are authorized to invade, slaughter, carry out genocide and nuclear-bomb nations with such impunity that the UN charter doesn’t even allow a resolution condemning them.

The Global Ceasefire proposal, therefore, needed the support of the big bullies.  

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The USA (read Trump) initially insisted the resolution must include ‘Wuhan virus’ in the text. It was duly rejected. After four weeks of virtual talks and several drafts, USA asked to remove references to the World Health Organisation. In this election year, WHO is Trump’s enemy no. 2. WHO has failed to confirm, as Trump would like them to, that the virus originated in a Chinese lab.

China and Russia said they would veto if references to WHO are excluded.

France, along with Tunisia, is the sponsor of this resolution. France persisted and developed a compromise. Reaching a compromise through international Zoom meetings is not easy. On Thursday, the final draft included the wording ‘UN specialized health agencies’. The Chinese and Russians approved it, since in their mind they read this as WHO. The negotiating Americans found the wording acceptable because WHO was not mentioned. Late evening on 7 May, Americans approved the final draft. On Friday, it would be placed before the Security Council for a vote, simply a technicality.

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On Friday, 8 May, USA used its veto power and blocked the resolution. It said “UN specialized health agencies was an indirect reference to WHO".

WWII continues to haunt us.

Ravi

Corona Daily 456: The Journey Home

Dhan, Nirlesh, Buddharaj, Rabendra, Dharmendra and Pradeep were siblings or cousins, all belonging to the Singh Gond family. The family hailed from Umaria in India’s state of Madhya Pradesh. Aged 22 to 35, they were all married, and four of them had children. With frequent droughts, large families can no longer survive on farming. The young men had bribed a middleman to get themselves a job in SRJ Steels at Jalna. Jalna is about a 1000 km from Umaria. Returning home once a year, the Sing Gond cousins had become part of India’s 40 million circular migrants.

They worked at the steel factory, but not for it. The steel factory avoided employing them to stay clear of all labour laws. A contractor paid each of them a daily wage of Rs 450 (6 $). Twenty of them rented a room, and tried to save something to send to their families regularly.

On 24 March, India announced a lockdown for three weeks. The next day the steel factory closed, and the daily wages stopped. On 1 April, the slum landlord demanded rent. The lockdown became chronic, only changing the end-date every time. The cousins kept assuring their wives they would return home. There was nothing to do in Jalna.

All trains and buses had stopped plying. The media was full of horror stories of migrants walking for miles on India’s highways in the blistering April heat.

Umaria was 1000 km away, and the Singh Gond cousins, though fit and young, wouldn’t contemplate walking that distance.

In May, the government announced special trains for labourers. The train from Aurangabad would take them to their village. And Aurangabad was 60 km away. Buddharaj, the only tech-savvy cousin, tried to apply for e-passes. But there was no response.

Their contractor disappeared, both his phones disconnected. That is when the Singh Gond cousins and their co-villagers decided they had had enough. If they must live without jobs and money, they were better off being with their families. On Thursday, 7 May, they called their families to give the good news.

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Twenty of them started walking on the railway tracks and covered 40 km in the night. Why rail tracks? You can’t lose your way, if you go the way the train goes. Living on survival food for a month, they didn’t realize how exhausting the journey could be. At three in the morning, they decided to take a nap. Aurangabad was another 20 km away. They would get up in the morning, and walk the rest. Well in time to catch the train. They slept on the wooden planks between the rail tracks. There was no chance of a train coming. No trains had run for more than six weeks.

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They never woke up. An empty goods train ran on the same track at 05.15 that morning. Three of the group had slept away from the tracks. They survived to tell the story. 17 died. 

India’s Prime minister tweeted his anguish- in English. BBC and CNN reported their deaths. The states offered Rs 1.5 million ($ 20000) compensation. On 8 May, their lifeless limbs were taken to their villages – by the same train they had tried so hard to catch.

Ravi

Corona Daily 457: Prisons Change People

New York’s governor Cuomo objects to the term ‘shelter-in-place’ used by some American states. That term implies a shooter on a rampage. Cuomo prefers to give ‘stay-at-home’ orders. Without caring for semantics, most of the world uses the word ‘lockdown’. Lockdown is part of prison vocabulary. Currently, nearly 4 billion people, half of the world, is locked down, essentially held prisoners.

True, this is house arrest, or home confinement, a milder form. Some countries use smart phones to tag and monitor people - mandatory in China, anonymously aggregated in Belgium, and voluntary in South Korea.

In a sense, our confinement is worse than the traditional prisoner’s. We have been punished without a trial for no crime of ours. We have been confined without an end date, our term indefinite. Inmates are fed by the State in prison. Here, we have to fend for ourselves, try and get enough supplies for our families. The mask is a constant reminder of our situation.

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Yesterday, I wrote about a Russian billionaire who committed suicide because he was unable to cope with the situation. It is useful to know the research that studies the way prisons change people. I will mention a few highlights.

It is shown the most damaging factor for prisoners is the loss of their life in the outside world, rather than the prison conditions. When first-time prisoners start their sentence, life becomes sedentary; they stop physical exercise, sit or lie in bed for more than 9 hours a day, don’t know what to do with the hours-time passes very slowly. The first month is marked by a preoccupation with safety, a sense of losing freedom and control, feeling of uncertainty, separation and loss. They can easily give up drinking and smoking. All other worries are so overwhelming in their mind they don’t miss sex. But they miss physical human warmth. (Hugging, kissing, handholding).

The process of adapting is called ‘prisonisation’. That process is filled with chronic stress and sleep disturbance. It can affect certain brain functions, such as planning, attention, working memory. After three months of imprisonment, there may be significant deterioration in self-control and attention.

Longer imprisonment may lead to emotional withdrawal, depression, suicidal thoughts or actions, increasing hostility, delusions, panic, madness, phobias, substance abuse and self-destructive behavior. A long imprisonment alters the prisoner for ever. As one ex-prisoner said: “I act like I’m still in prison, I mean you are not a light switch or a water faucet. You can’t just turn something off. When you’ve done something for a certain amount of time, it becomes part of you.”

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Worldwide governments need to take lessons from this, and ensure the confinement doesn’t become too long. In order to save the vulnerable, we don’t want nations becoming mental asylums.

And as individuals, we should be aware of such studies, so that we can avoid the pitfalls of confinement.

Ravi

Corona Daily 458: The Russian Oligarch

Dmitry Bosov’s estate lies in an area known as Rublyovka, a 40 minute drive from the Kremlin. These forests were popular hunting grounds with the Russian Tsars. Every ruler from Lenin, Stalin to Putin has had his official residence here. Rublyovka is a billionaires’ ghetto. Some of the world’s costliest houses are located here. When the oligarchs shop at the Barvikha luxury village, purchases include not just Prada and Gucci, but also a Bentley or a Maserati.

Dmitry Bosov, 52, is among the Russian $-billionaires. His house stands on a 5-hectare (50,000 sq meters) plot. The gigantic place has a gated, camera-observed driveway, leading to a spacious car park. The house is surrounded by grassy lawns, swimming pools, a spa, a Russian sauna, gardens, mature trees, thick hedges, a fitness center and an ice hockey ground. In May, with spring gradually journeying towards summer, the surroundings are fresh and lively. Bosov lives a short walk from President Putin’s dacha. In 2016, he sponsored a hockey league in which Putin and he played together.

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This year, the start of the Moscow lockdown coincided with Bosov’s birthday. A coal baron, he had to cancel his grand birthday celebrations.

Like any Russian oligarch, Bosov has conflicts in business and family, problems with booze and insomnia, but he has had them for the past thirty years. In January this year, he bought a multi-million mansion in Beverly Hills, for an occasional change of weather. But now he can’t travel to California, not even in his private jet. Coal prices are falling. But his biggest concern as he discussed with friends is that the pandemic will cause such poverty in Russia that the poor will revolt.

In the 1917 revolution, it was not just the Tsar’s family that was assassinated. Several aristocrats were killed, and each bedroom from their grand apartments was given to individual families to conceive the Soviet communal apartments. Worried, Bosov re-checked the CCTV cameras, the gates, and began carrying his pistol on his person. Last week, on 30 April, Russia’s Prime Minister Mishustin, whom Bosov knows well, tested positive. The Russian numbers have crossed 150,000, with 1500 dead. Every day 10,000 more cases are springing up.

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Yesterday, on 6 May, Katerina, Bosov’s wife, called him over the phone. When you live on a 5-hectare plot, you need phones to find your family. After several unsuccessful calls, she went to security and began checking the CCTV footage. It showed Bosov entering the fitness center in the night. Katerina and the guard rushed to it. The door, locked from inside, had to be forced open. Dmitry Bosov, the billionaire, was found dead on the floor, with a bullet in his head. His Glock 17 Gen 4 was lying next to him. No suicide note was found anywhere.

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It is likely thousands of super-poor will die in the pandemic. The case of the Russian oligarch shows it can claim some super-rich as well.

Ravi

Corona Daily 459: Professor Lockdown

On 5 May, 51-year old Professor Neil Ferguson, the UK’s most influential epidemiologist, scientist and architect of the UK lockdown resigned as a government advisor.

Prof Ferguson has more than twenty years of experience with pathogen outbreaks. His predictions have not always been accurate. In 2001, during the foot and mouth outbreak, he said 150,000 could die. Based on his advice, as a precaution, 6 million animals were slaughtered. In the end 200 people died. For his Foot and Mouth models, he was bestowed with the Order of the British Empire (OBE). During the 2002 Mad Cow outbreak, Ferguson feared up to 50,000 might die. 177 died. In the 2005 bird flu epidemic, Ferguson estimated 200 million could die. 282 died. In the 2009 Swine flu epidemic, he predicted 65,000 deaths. Final figure was 457. Epidemiology is not an exact science. Prof Ferguson has candidly said he doesn’t own a crystal ball. His track record was not the reason for his resignation.

Professor Ferguson is a deemed Patient Zero in Westminster. At 5 pm on March 17, he had a speech at 10 Downing Street. He greeted Boris Johnson and his cabinet (perhaps by shaking hands), gave his revolutionary speech and left. Next morning he woke up with a high fever and dry cough. On 19 March, he tested positive. On 26 March, PM Johnson, UK’s health secretary Hancock and Chief Medical Officer Whitty tested positive. By 30 March, half of the cabinet was infected. Johnson nearly died. But this suspicion of being the pioneer transmitter did not cause his resignation.

Before his revolutionary speech at Downing Street, UK had focused on ‘herd immunity’. Instead of suppression it relies on developing mass immunity by facing the music. Prof Ferguson singlehandedly changed it. He presented models which showed 510,000 British citizens could die, unless a strict lockdown is implemented. Not only did UK reverse its strategy, inspired by the Ferguson figures; France, USA and Germany went for strict lockdowns. PhDs from Oxford command worldwide respect. Based on the professor’s advice, Johnson addressed the nation on 30 March. He recommended the strictest lockdown. “You should not be meeting friends. If your friends ask you to meet, say no. You should not meet family members who don’t live in your home.” Aptly Neil Ferguson is nicknamed Professor Lockdown. He managed to put 66 million Brits under house arrest.

This week, the Telegraph revealed Prof Ferguson’s 38-year old lover has been visiting him secretly. Why can’t they live together, which is permissible under lockdown? They can’t. She lives with her husband and two children in another part of London. On 30 March, on BBC Today Prof Ferguson was telling the nation the criticality of a strict lockdown. Reportedly, when he was broadcasting, his lover was hiding in his bedroom.

The professor accepted he made an error of judgment. He deeply regretted undermining the clear social distancing message. He emphasized the government advice was unequivocal, it protects everyone. With that, he resigned.

Ravi 

Corona Daily 460: The Warren Buffett Annual

Born in August 1930, Warren Buffett often jokes he is the result of his parents being locked down at home in the Great Crash of 1929. Known as the world’s wisest investor, he was the world’s richest man in 2006 (currently fourth). His position has declined only because of his philanthropy. Until 2006, he didn’t have a mobile or a computer. Before 2013, he had sent just a single email in his life. Buffett insisted his children travel in economy class. ‘I want to give my kids just enough so they would feel they could do anything, but not so much they would feel like doing nothing.’ He famously said.

The Oracle of Omaha (his nickname coming from his birthplace) has survived WWII, the Cuban missile crisis, 11 September, the 2008 financial crisis, and on a personal level, cancer. He is a master showman. His words and actions are capable of shaking the financial world.

Buffett is the chairman of Berkshire Hathaway. The AGM weekend is a busy affair in Omaha every summer. Downtown Hilton charges 700$ a night for the cheapest room. Last week, the Hilton room was 125$ with no takers. Around the AGM, the Omaha airport is packed with thousands of shareholders, super-rich all of them. (Before Corona, the share price had reached 347,000 $ per share, meaning you needed more than a million $ to buy just three shares of BRK-A. Now the prices have fallen by 20%. For a little over a million $, you can buy four shares). This year, the airport was empty. Every year, some 40,000 shareholders jostle to buy Berkshire Hathaway merchandise. This year there was no shopping, and no shoppers. Fearing some crazy shareholders would rush to Omaha anyway, the AGM venue was not disclosed.

The AGM on 2 May was supposed to be Bill Gates’ last meeting. He is leaving the board. But he didn’t attend. If you think Buffett, 89, is old, the deputy chairman, Charles Munger, is 96. They are partners for sixty years. (Munger didn’t attend because his age makes him vulnerable).

Buffett addressed shareholders online for over 4.5 hours. The American economic miracle will prevail, he said, as he says every year. But he admitted to selling all airline stocks. Since 2016, he had owned 10% of United, Delta, American and Southwest. Now he owns nothing. On Monday, promptly all airline stocks crashed.

America’s best days lie ahead, he said. But he admitted he had stopped investing currently. Despite his company sitting on 137 billion $ in cash. In 2008, a month after the crisis, he was buying big. Not this time.

He said this was the best time to be born in America. But his speech was atypically sober (or somber). The wisest investor said he doesn’t know what the market is going to do now.

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He admitted he hasn’t had a haircut for seven weeks. That was one line everyone understood and empathized with.

Buffett is known for always taking a long-term view. Short-term crises have never bothered him. His performance on 2 May, at the age of 89, suggested that perhaps his definition of long-term has changed.

Ravi

Corona Daily 461: To Spit or Not to Spit

India and China are the world champions when it comes to spitting in public. China’s Deng Xiaoping issued anti-spitting rules in 1980. Despite that, when he met international leaders, he had a spittoon placed near him. During the 2008 Olympics, Beijing tried to run an anti-spitting campaign (unsuccessfully). The Chinese still consider spitting acceptable and essential to clear the throat of dust and grit.

Indian democracy allows free speech and free spitting. Indians chew an exciting combination of tobacco and betel leaf, forcefully spitting out the remnants to splatter roads and walls. Like everything else in India, spitting is colorful.

The novel Corona virus is changing all that. Many Indian states have now imposed fines on spitting. Himachal Pradesh has introduced legislation treating spitting as an attempt to murder. The director of police clarified that if the recipient of the spit becomes infected and dies, the spitter will be charged with murder. Two reasons why nobody is charged so far. One is the masks, and second the unavailability of chewing tobacco.

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In the West, though, there is an epidemic of spitting. In Europe, New Zealand, USA people have been charged spitting on the police, on medical staff, on jailers. In New York jails, spiteful inmates are using it as a weapon, freely coughing and spitting on correction officers.

In the UK alone, several people were arrested and jailed to anything between three and eight months for spitting on the police. The culprits included men and women, Whites and Asians. In Saudi Arabia, a man who spat on the shopping trolley in a mall now faces death. (It seems he is alive only because the Saudis are discussing whether stoning him would be safer than beheading).

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Sport, though dysfunctional, is also affected in a big way. Soccer players spit more often than they score goals. FIFA is considering giving a yellow card to players spitting on the football field.

Cricket will may not have a T20 world cup this year. The sport’s fast bowlers routinely spit on the ball between deliveries. They then rub the saliva to bring shine to the ball in order to swing it. ICC, cricket’s international body, is now considering banning that practice. The ban may put an end to swing bowling.

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While lawmakers, law-enforcers and law-interpreters are busy sending spitters to jail, what are the scientists and health authorities doing?

Testing is known to be critical in this pandemic. The current test sticks a q-tip-like swab deep into your nose or throat, to retrieve a sample of mucus which may or may not contain the virus. This test is invasive and uncomfortable. Also the medical person needs to sit in close proximity to the individual to be tested.

Scientists at Rutgers University have now suggested spit samples instead of throat swabs. On 13 April, America’s Food and Drug Administration granted the spit-tests an accelerated emergency use authorization. If successful, all you have do is: spit a glob of saliva into a cup, close the lid and hand it over. Easier than giving a urine sample.

After declaring spitting a punishable offence, Governments may now have to ask billions to start spitting again.

Ravi