Corona Daily 446: Refugees without Refuge

Human suffering is limitless.

On 14 May, Kutupalong, near Cox’s Bazar in Bangladesh had its first case of Coronavirus. The sprawling stretch of 34 refugee camps, the world’s biggest, shelters nearly a million Rohingya refugees. A few of them have now tested positive, a dreaded scenario for Bangladesh.

Rohingyas originated in Myanmar (formerly Burma) nearly five thousand years ago, when Islam didn’t exist. Converted to Islam by Arab merchants, they were concentrated in Arakan. In the 1970s, the Burmese army and dictatorship began its relentless campaign against Rohingyas. Arakan was renamed Rakhine, after the Buddhist Burmese people. Rohingyas were (falsely) called Bengali immigrants, made stateless, their legal rights withdrawn. With a combination of apartheid and genocide, the brutal Burmese Junta tried to get rid of them. Aung San Suu Kyi, an otherwise respectable woman, lost many admirers due to her silence around the atrocities.

In 2017, 800,000 Rohingyas fled to Bangladesh to find shelter in the now infamous refugee camps. Bangladesh is a reluctant host. The refugee camps are covered with barbed wires not for the protection of refugees, but of Bangladeshis. The government has cut off all phones and internet from the camps. Rains and floods cause chaos in the monsoons. The camps are located on the roads that were previously an elephant migration route. Occasionally, wild elephants enter the camps and trample a few refugees.

For the past four years, Bangladesh has been planning to relocate Rohingya refugees to Bhasan Char, a nearby island. In 2006, the 15 sq mile island was formed naturally by the millions of tons of silt that flow from the peaks of the Himalayas. Between June and September, the island disappears under water. The Bangladeshi government has not allowed foreign observers or Rohingya representatives to visit the island. Recently over 300 refugees tried to flee to Malaysia by boats (another name for the Rohingya refugees: the Boat People). The Bangladeshi navy caught and placed them on this island. The fate of these first residents will be known in June when the floods begin.

Rohingya refugees, the world’s most persecuted people, have so far survived Burmese brutalities, malnutrition in camps, rains, elephants and the dreaded transfer to Bhasan Char Island. Coronavirus is their latest, but not the last challenge.

Tomorrow, on 20 May, a category four super cyclonic storm Amphan (meaning sky) is going to hit Bangladesh and the North East of India. A five to ten feet high storm followed by floods is expected to cause havoc in low lying areas.

In the Rohingya refugee camps, the danger signal has been elevated to 6.

Ravi

Corona Daily 447: Is Covid a He or She?

If you were to cross the scenic Pont des Arts from the Louvre in Paris, you will reach the magnificent Académie Française on the other side of the Seine. A heritage building founded in 1635, it is the custodian of the purity and authenticity of the French language. A maximum of forty invited and elected members, (expensively dressed and entitled to carry swords) issue rules and guidelines for French speakers. Though they are not, they are called the immortals - a reference to the language they guard.

Mostly comprising elderly gentlemen and occasionally a lady (732 immortal men and nine women, until now), they have carefully protected the French language. The group includes novelists, poets, literary critics, philosophers, historians and the odd foreigner who commands mastery over the French language.

Since the beginning of the Covid pandemic, les immortelles have been upset and disturbed because they see and sometimes hear la covid, other times le covid. Of course it is not possible for Covid-19 to be both masculine and feminine, pushing these expert French linguists to heatedly debate its gender, on video, of course. With 25,000 French citizens already dead of Covid-19, they finally issued their verdict on 7 May.

Covid is feminine.

Like primary school teachers, they offered a detailed philological explanation. An acronym or abbreviation must first be unfolded to see its full form. Then the gender of the key word looked at and applied to the acronym. That is why FBI is masculine, but CIA is feminine. Because bureau is masculine, whereas agency (agence) is feminine. Disease (maladie) is a female in French, therefore Covid becomes a female as well.

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What the legendary Académie Française pronounces is not binding on the public. These old masters try to stop the invasion of English language into France. They recommended mobile multifonction when smartphones appeared. And tried to replace the catchy le wifi with l’access sans fil a internet. If you use that phrase no Parisian will understand what you are saying.

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In Indian languages, both ‘virus’ and ‘disease’ are masculine. (And everybody knew it without an academy). Italian, Spanish and Portuguese languages declared Covid-19 to be feminine in March itself. Russian and Polish also have genders for nouns. It is important to know the gender before you can translate novel coronavirus. In Polish, a novel boy would be nowy, a novel girl nowa, and a novel child, nowe. Just to clarify: Covid-19 is called a coronavirus infection in Russian, and is feminine, because infection is feminine. In Polish, Covid is feminine because disease (choroba) is feminine. Virus is masculine in both.

In short, in European languages a nasty male results in a dangerous female.

Ravi

Corona Daily 448: Operation Tiger in Kent

On Saturday, 2 May, at 10.23 a.m., the Sevenoaks police station phone rang. The Kent police have been overwhelmed with complaints about those breaking stay-at-home orders. But this call was different. The caller had seen a large wild tiger at Mote road in Ightham village. As per procedure, the police constable noted the caller’s details. He then informed his superior, who whistled on hearing it. Everyone was overworked, but a tiger was more exciting than a virus.

It took the efficient Kent police only twenty minutes to organize ten armed police officers. Ightham was merely four miles away. The village, known for cob trees, is surrounded by massive woods. The police Land Rovers would need to cover a large area. The police chief had asked for a helicopter to assist them. It would be easier to sight the wild cat from the skies.

Two cyclists were stopped next to Ightham Mote, the well known medieval manor house. The cyclists without masks were terrified, but what the police said surprised them. ‘Get out of the area, as soon as you can, and don’t leave the main roads, because a tiger is on the loose’.

Fortunately, there weren’t any people on the roads. The police had decided not to use the megaphone. It may provoke the tiger into action. From the jeeps, they saw the roving helicopter above them. Phone contact was established. It was a matter of minutes before they would locate the tiger.

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With a population of about two thousand, Ightham is not large. Last few weeks were quieter than usual. The sound of the helicopter made the residents restless and puzzled. Many came out of their houses to watch it.

85 year old Juliet Simpson was in the kitchen when her son, Duncan, called her. ‘Mum, there are armed police on the hill going in the direction of your house. Don’t know what’s happening.’

My goodness, said Mrs Simpson and came out of the house. She saw the approaching Land Rovers. The police chief, carrying his loaded gun, came out of the car. He was informed by the helicopter pilot that the tiger sat basking in the sun in the garden of this house.

‘Would you like to be introduced to the tiger?’ The smiling Mrs Smith asked the policemen. They all followed her.

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Juliet Simpson is a sculptress. Twenty years ago, she had sculpted the tiger with wire and resin. It looked admirably lifelike. The relieved police chatted pleasantly for twenty minutes and left. As to why the tiger that was stationary in the same place for twenty years should cause such mayhem today, the police explained later.

It seems in March and April; Netflix showed the documentary series ‘Tiger King- murder, mayhem and madness’. This series was watched widely during the lockdown in Kent.

Ravi

Corona Daily 449: Seksbuddies in Netherlands

On 15 May, the Netherlands officially advised single men and women to find themselves a seksbuddy (sex buddy) or a cuddle buddy.

Netherlands is a marvelous nation, perhaps the freest on earth. It is open, transparent, equal-for-all, matter-of-fact and no-nonsense. Going Dutch is a term we are familiar with. Recreational drugs are officially sold. Amsterdam’s De Wallen is a glamorous, picturesque red light district. It is a rare country where patients in extreme agony can peacefully end their life with the doctor’s help.

On 23 March, Netherlands began its strict lockdown. Neighbouring UK advised couples not living together “to test the strength of their relationship”. (A famous George Mikes quote: On the continent people have sex; in England they have hot-water bottles).

The Dutch National Institute for Public Health and the Environment (RIVM) gives official advice to its citizens. Some FAQs on their website asked “Can I still have sex now that coronavirus is in the Netherlands?”

Yes, the advice said, you can have sex. But keep a distance of 1.5 meters. Webcam sex or DIY (do it yourself) is allowed. Group sex is no longer possible. But group sexting on Skype or Zoom is possible. The Dutch call theirs an ‘intelligent lockdown’.

While keeping a distance of 1.5 meters, the couples were advised to tell each other erotic stories. It is possible the Health institute started online storytelling classes. (If they are in Dutch, English subtitles should be added so that other nations can benefit).

Over the last six weeks, the government realized they had forgotten about the singles. Singles had nobody to tell stories to. One love expert said sex is a human right. Another called the deprivation “skin hunger (huid honger)”.

Finally, yesterday, as a measure of relief to the singles, the government officially advised them to find “sex buddies” or “cuddle buddies.” Of course, great care should be taken in the selection process. Buddies and their contact-circle should be disease-free. Singles and their buddies should come to a mutually satisfactory agreement to keep themselves safe.

They should not use public transport to visit each other. Before starting anything, they should wash hands. After it is over, they should wash hands. After that, the advice becomes a bit ambiguous when it says: wash hands when you touch your partner. What does that mean? Does the government expect the romance to happen next to a washbasin? Or in a bathtub?

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Anyway, the humane advice of the Dutch government appeared to be misunderstood or distorted on the Dutch social media today. Multitudes of texts asked for buddies. Hundreds of ads appeared online as well.

Frightened by this response, the government Health institute removed the words ‘sex buddy’ and ‘cuddle buddy’ from the website. It also clarified that its nuanced message was distorted. It never intended to promote arbitrary sex. The Dutch government wants singles to have safe sex with someone in a committed relationship.

Ravi

Corona Daily 450: The Intelligent Senator

Late evening on Wed. 13 May, Richard Burr, a Senior USA senator, heard the doorbell ring. Even senators get startled by a doorbell these days. He opened the door to find FBI agents outside. They carried a warrant to confiscate his i-phone. A seasoned politician, Burr handed it over. What he didn’t know was that his i-cloud information was already under investigation.

Richard Burr has been the Chairman of the Senate Intelligence Committee since 2015. In that capacity, he has access to classified information. In February, he was receiving daily briefings on the Coronavirus. On 7 February, he wrote an op-ed comforting the American public that the USA was better prepared than ever before.

On 12 February, two events happened. Burr received another classified briefing from health experts, explaining the gravity of the crisis. The same day, the US stock market reached its peak.

On 13 February, Burr and his wife, in 33 different transactions, sold up to 1.7 million $ worth of stock. They got rid of all their hospitality shares. On the same day, coincidentally, Burr’s brother-in-law also sold a major portion of his stockholding.

Kelly Loeffler from Georgia is one of the richest senators. She and her husband sold up to 3.1 million $ worth of stock. Her husband is the Chairman of the New York Stock exchange.

On 24 February, the stock markets began to collapse, and went down 32%. Burr saved at least half a million $ through his “timely” actions. Burr said his stock selling was based on knowledge available in the public domain, nothing to do with classified information. (Why didn’t smart fund managers use this public domain information in as timely a manner)?

Loeffler said her actions showed not corruption, but transparency.

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Obama’s administration had introduced the STOCK act to prevent exactly such insider trading. The need was so obvious that the “Stop Trading On Congressional Knowledge (STOCK) act, 2012” was passed by the senators 96-3. Richard Burr was one of the three opposing senators.

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Is this one of the reasons why we, the public, receive information too late? Politicians with structural access to classified information get early warnings. They spend some time in securing their self-interest first. Then allow a couple of weeks for corrupt actions to cool down. The privileged information known to Burr and Loeffler was relayed to the general public a month later.

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Kelly Loeffler says she and her husband have never used any confidential information. However, in order to avoid the distraction, they decided to sell all their individual stocks.

Richard Burr maintains his innocence. However, on 14 May, he resigned from his powerful post as Chairman of the Senate intelligence committee.

Ravi

Corona Daily 451: The Doctor’s Dilemma: Part Final

Yesterday, I talked about the worldwide rationing of masks, tests, protective gears, ICU beds, ventilators, medicines. (Vaccines when they appear will also need to be rationed.) As the numbers shoot up, the health care fraternity is increasingly forced to make life-death decisions.

In their paper “Fair allocation of medical resources in the time of Covid-19”, bio-ethicist Dr Ezekiel Emanuel and his colleagues make important recommendations. This medico-ethical framework is well worth considering for any hospital in any country.

Saving lives and saving years of life: Assuming life expectancy to be 80, saving one 20-year old is more utilitarian than saving two 60-year olds. The two older patients will lose 20 years each, whereas the younger patient will live another 60 years if saved. Hospitals should decide the balance between lives and life-years and consistently apply it.

(Of course, this approach can’t take into account the economic or mental quality of the patient’s life. If that young 20-year old has a miserable life, he may have another 60 years of misery. Such considerations are beyond the scope of ethics in medicine.-R.)

Doctors, nurses top priority: Medical front line workers and first responders (ambulance) fighting covid-19 should get top priority irrespective of their age or condition. A single doctor or nurse saved may save another hundreds or thousands of lives. The paper calls it their instrumental value. Similarly, if there is a vaccine developer, saving her before others is critical. Besides being fair, this strategy boosts the morale of the medical staff.

Triage officers and lottery: The paper opposes a first-come-first-served policy by pointing out several shortcomings. If prognosis is similar across patients, random selection or lottery is suggested. Wealth or fame should not be considered. (The Trumps and Johnsons of this world will anyway manage on their own). The system should be transparent – patients should be informed about the rules in advance.

Removing a patient from the ICU or ventilator to make space for another is ethical; it is not killing, and doesn’t require a patient’s consent.

A key suggestion is to appoint a neutral triage medical officer or a committee, to take these decisions. Making life-death choices for patients they are treating would traumatize the doctors. (Unfortunately, front-line doctors are reportedly making those decisions in many countries, including Italy).  

Priorities differ for vaccines: Health workers remain at the front of the queue for vaccines. Older people can be prioritized next.  Though a younger person may be first given a ventilator (curative), a vaccine in shortage (preventive) should be given to old people first.

Don’t distinguish between Covid-19 patients and others: The health care system that is strained by Covid-19 is either refusing to entertain other patients, or other patients are reluctant to visit labs and hospitals. Several pregnant women are delivering at homes, despite the inherent risks. The paper suggests applying the triage rules equally for Covid-19 and non-Covid-19 patients. The lives of patients suffering from other diseases are as valuable as those inflicted with covid-19.

Ravi

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