SHORTAGE: Though Chief Minister Pramod Sawant ordered five lakh doses of Covishield, Goa has received less than 50,000 doses of the vaccine from Serum Institute of India. Covaxin is being offered but there is not much interest in taking it because it has not been cleared by World Health Organisation.

By Rajan Narayan

The only guarantee of ending the second covid wave and preventing the third wave is to vaccinate at least 70% of the population of Goa. This will ensure herd immunity which would stop mass spread of the contagion. The success of mass vaccination has been proved in the United Kingdom and the United States where requirement to wear masks in public has now been withdrawn!

EVEN as we seem to be still in the grip of the second wave, there is already talk of the third wave. According to the Head of the Department of Preventive Medicine at the GMC Dr Jagdish Kakodkar, the third wave of the covid contagion is likely to begin by September. Though it will affect everybody the main victims will be children. The question that we have to ask is how to put an end covid-19? After the third wave there will likely be another wave and so on. Chief Minister Pramod Sawant claims that a committee is set up including Dr Virendra Gauns, the veteran paediatrician who now heads Healthway Hospital.There are already plans to expand the paediatric ward and set up a special ICU for kids in the super speciality block in GMC. The problem with any third wave which targets kids is that the entire family is likely to get infected.
Unlike adults there is no way kids can be isolated. They will interact with all members of the family and carry the infection to them. In fact, the concept of isolation in relation to covid-19 is not understood by most Goans. Even in the covid wards of the GMC there are flocks of relatives who don’t seem to mind getting infected. We cannot blame the relatives entirely because the shortage of staff is so acute that as many as 50 to 100 covid patients have to be taken care of by a single doctor and a couple of nurses and ward boys. When something like the drop in oxygen pressure takes place the staff will not know whom to attend. The government no doubt is trying to desperate recruit more staff.
It has advertised for recruitment of a hundred MBBS doctor on the starting salary of Rs65,000 a month. The Directorate of Health Services (DHS) did not receive a single response for the walk-in-interview. This despite the fact that 180 medical graduates pass out of GMC every year. Of this 30 are from the Central quota and probably go back to their home states. The rest are either already working for the GMC against the bond period.
Every GMC MBBS graduate has to work for one year for the government before he/she can get their graduation certificate. Even those who have completed the bond period are busy preparing for the national eligibility test for admission to post- graduate courses and diplomas. A mere MBBS does not command much respect from patients. Every patient wants to go to a specialist, preferably someone trained abroad.
If we cannot stop the third wave peoples’ problems will become more severe. In the case of the second covid-19 wave any post- graduate in medicine could treat patients.
But serious cases of covid-19 require expert treatment from pulmonary specialists, doctors who are experienced in problems relating to respiration and the lungs and how it has bearing on the organs of the body.
With the spread of the bacterial black fungus infection amongst covid-19 patients, we also need gastroenterologist surgeons. This is because infection growth in the oral and nasal tract have to be excised using an endoscopic surgery equipment (reportedly the bacterial infection is the result of indiscriminate use of steroids). A thin tube is slipped through the nose and throat cavities with surgical attachments and these perform the surgical operation.

DIABETES PATIENTS

A THIRD specialist who is needed is a diabetes consultant for diabetic patients whose blood sugar may be fluctuating badly are prone to bacterial infections much faster. Diabetic covid patients are at greater risk of catching the fungal black infection. In fact, cases of fungal infection are so much on the rise now that Centre is considering declaring back fungus as an epidemic on its own.
Those following the daily bulletins issued by the Directorate of Health Services would have noted that there has been a significant decline of deaths from 60-70 to 30-40 cases daily. But Goa’s positivity is still amongst the highest in the country at 35%. The positivity rate is the proportion of people who test positive of those who come for RPT-CR tests every day.
IT is a fact that the second wave which led to a high rate of mortality for covid patients is linked to the ill-advised early opening of casinos and rolling out the red carpet for tourism by Pramod Sawant. This is dramatized by the fact that when belatedly curfew and entry into Goa was limited to only covid negative certificates the number of cases in Candolim have come down significantly. The Candolim Primary Health Centre covers the northern beach belt of Candolim, Calangute and Baga.
But the number of cases in the commercial capital of Margao continues to be more than a 1,000 positive cases daily (down from 2,000 cases). The good news is that the positive cases in Panaji have come down by 50%. The number of fatal cases due to a drop in oxygen pressure appears to have almost completely stopped. What is worrying is that there is an increase in the number of deaths in private hospitals. Not in corporate hospitals like the Manipal, Healthway SMRC or Apollo Victor, but in the 27 small nursing homes which the government has forced to reserve 50% of beds for covid-19 patients. The biggest problem is shortage of staff be it doctors or nurses. The majority of even corporate hospitals find it difficult to get MBBS- qualified doctors to serve as resident doctors. All the smaller hospitals employ Ayush doctors. The DHS too has decided to hire Ayush doctors who will work under the supervision of the MBBS doctors.
The few nurses with nursing diplomas from neighbouring states like Karnataka, who used to work for corporate hospitals, have joined the GMC as better paid contract employees. Everyone is prepared to take a government job even if it is on contract basis, in the hope that they will be regularised later. The probability is that once covid-19 cases come down in number all the contract employees will be sacked.
How do we bring an end to the second wave? Lockdowns are not a solution as they take away the livelihood of several lakh people. If supermarkets and malls are shut the staff don’t get salaries. With the curfew restriction of working from 7am to 1pm they need much less staff. Recruitment to government jobs with the exception of covid-related jobs has come to an halt.
Drivers of private buses have no jobs during a lockdown. Without tourists there are no jobs for taxi-drivers. With hotels and restaurants shut except for kitchen takeaways there is a sharp drop in jobs in the tourism sector. The curfew rules are so absurd that even if you go to Subway you cannot pick up a sandwich, you have to order it from Swiggy or Zomato. When I ask any of the five-star and seven-star hotels for advertising support they prefer to send me food as if I am starving patient suffering from covid at home! I understand the sardarji kids working for Gopal Kunda of Big Daddy casino were down with covid, but with the casino closures they are now doing the work of distributing food packets in association with the Betim and other gurudwaras of Goa to the relatives of covid-19 patients at the GMC wards.
Can the second phase of covid-19 be brought to an end? Can the lockdown be lifted and jobs restored at least by June 1? Or will the partial lockdown called curfew be further extended? Going by the experience of the United States and the UK, the only way of saying goodbye to covid is mass vaccination. Stupid India, thanks to Prime Minister Narendra Modi, exported millions of doses of Covishield to the UK and the USA. Because Modi believed that mahaan Bharat had conquered covid-19. That there will be no more covid in second and third and more waves.

VACCINE SHORTAGES

MY SISTER-IN-LAW in the US had a Covishield vaccination. But there are no Covishield vaccines for me to have my second dose. Between Serum Institute and Bharat Biotech they produced nine crore doses of Covishield and Covaxin vaccines a month. But for some mysterious reasons only 5 crore vaccines were distributed to the states and private parties. The additional complication is that Covaxin made by Bharat Biotech has still not been recognised by the World Health Organisation (WHO). Which means students who have taken it cannot go abroad. The airlines also do not recognise Covaxin as passport to travel. There is apparently a shortage of more than ten lakh doses a day.
Delhi has stopped vaccination all together for lack of stocks. Goa which ordered five lakh doses of Covishield received less than 50%. Ironically, all the distribution of vaccines is controlled by the Centre. Modi did not allow Congress-ruled states like Punjab to order Moderna and Johnson vaccines directly.
AT the present rate of the production of vaccines it is unlikely that even 50% of Indians will be vaccinated by the end- 2021. Without vaccination of at least 60% of the population the herd immunity, which stops the spread of the infection, cannot be achieved. The US and UK have been able to vaccinate almost their entire population free because their population is small. In contrast to India which has a population of 360 crore.
It is extremely unlikely that the majority if not the entire population of India can be vaccinated. But Goa is the small state. At the most it has a population of 20 lakh. If the government wants to and the Centre provides enough stocks of vaccines, it should be able to vaccinate ten lakh people by end-July.
Already about two to three lakh have been vaccinated, comprising senior citizens over 60 and people in the age group of 18 to 44. Fortunately now people want to be vaccinated and willing to line up for their jabs, but there is a shortage of vaccines. People are lining up but there is a shortage of vaccines. All stocks are over or so one is told.
In Margao there is an additional problem. There is a fight between the bhaile (outsiders) and bhitorle (insiders). All the employees of pharma units in Verna are driving out the goenkars from the Margao vaccination centres. The other problem is with migrants who probably comprise 40% of Goa’s population. To get vaccinated in the 18 to 44 age group category you have to apply for a slot on the CoWin app. Most migrants don’t have a smart phone and even if they do are not savvy enough to book vaccine slots for themselves. It has become a game of fastest finger forward first. As in the case of television programs like Kaun Banega Crorepati’ andKonak Vaccine Melta’ it all depends on how smart and savvy a smart phone user are.
It is possible to revive the Goan economy. It is possible to bring tourists back to Goa. Till up to March Goa was flooded with tourists. But we cannot afford to permit anyone from coming into Goa without a covid-19 certificate. We cannot sacrifice the lives of Goans for the sake of tourists. We have to follow the Maladives model. The Maldives are a large group of islands with each island a holiday resort in itself. Most Indians money enough to burn are flying off to the Maldives. Excepting that since some Indians tried to go there with fake certificates. Now the Maldives have stopped accepting Indian tourists.
In fact, no country in the world wants Indian tourists. The UK and the US have banned them. Students are an exception. The Gulf enjoys the most popularity when it comes to popular job destinations for Goans and migrants in Goa. For the survival of Goa it is necessary that we vaccinate the majority of the population and as fast as possible. All those who are busy supplying food should instead be permitted to take boxes of vaccines to do home to home vaccination. That is the only hope of ending the second wave and stopping the third wave. Protecting the nearest and the dearest. The gentle buds who make up our children must be protected from Covid-19 at any cost.

SAY NO TO STEROIDS

A SMALL piece of advice from my personal experience. Stay away from steroids. Not only because it is the abuse of steroids which is causing black fungal disease. But because while steroids work magic for the short term, they are killer drugs in the long term.
During my Herald editorship years and a severe beating up in the line of work I was taking on an average 50 to 100 milligrams of steroids a day. All due to the stupidity of then GMC’s Head of the Department of Medicine, a Dr NGK Sharma. I nearly lost my sight in both eyes and suffered severe glaucoma. I still have some of the magnifying glasses I resorted to continue my reading and writing. Steroids caused water retention. My weight rose to 180 kg and I looked like a sumo wrestler. Steroids make your bones brittle. If I had a fall I would have multiple fractures. Stay away from steroids and doctors like Dr Haradatta Karande who consider steroids a wonder drug.