Acceleration of  COVID-19 transmission through various religious gatherings has been observed in many places in India. It is necessary to adopt and follow strict mitigation measures, otherwise the festive season can turn out to be a super spreading event which eventually may prove to be a burden on the healthcare system.

COVID 19 transmission dynamics is closely related to the 3 Cs:

• CLOSED SPACES with poor airflow
• CROWDED PLACES
• CLOSE CONTACT settings with face-to-face contact

Some of the upcoming mass gathering events such as ‘Navaratri’, ‘Durga Puja’, ‘Dussehra’ etc. will need comprehensive strategic planning in organising them in the current pandemic situation and a collective decision will need to be taken in the form of a consensus from key stakeholders such as policy makers, representatives from religious organisations as well as experts. In this context it is essential to formulate and implement strict standard operating procedures on preventive measures for containment the spread of COVID 19 during the festivals.

The logistics of the festivals including the expected number of people,dates and the potential barriers to control the crowd needs to be discussed with the local government and health authorities.

SOME USEFUL TIPS:

The following guidelines for religious places of worships during festival times and elaborate administrative and general preventive measures can help keep safe from the spread of Coronavirus:

1. No festival related events should be allowed in containment zones

2. All gatherings in connection with upcoming major religious events such as Dussehra, Durga Puja, Vidyarambham etc. should focus on maintaining a relatively safe cluster participation and limited participants

3. All vulnerable populations such as pregnant women, children, geriatric age groups, and immunosuppressed individuals should not attend public religious activities

4. Unvaccinated individuals should be encouraged to avoid gatherings.

5. Norms related to maximum number of permitted persons to celebrate the festival in every setting must be complied with the existing state government guidelines

6. On arrival at religious settings and while attending festivals, all visitors must wash/sanitise their hands frequently

7. Maintaining physical distance of 6 feet wherever possible and always wearing face masks properly is a must.

8. Double masking must be followed, and local government authorities should be deployed to ensure adherence

9. Under any circumstances, symptomatic visitors must not be allowed for darshan and attending the festivals

10. If any of the visitors experience any COVID-like symptoms, viz., fever, cough etc, they should immediately contact the medical teams stationed there

11. Authorities must ensure that no dining should be promoted inside religious settings. In unavoidable cases, appropriate physical distancing must be followed.

Dr Merlin Moni

Associate Professor

Division of Infectious disease

Amrita Hospitals

Kochi, Kerala state

The post Safe Conduct of Festivals : Preventive measures to control COVID  infection appeared first on Health Vision.

Holi, the much-awaited festival of colours is just around the corner. However, this year, as we are already witnessing the second wave of Covid-19 and once again in the month of March the corona cases are increasing at a faster pace, hence, people are strongly recommended to avoid participating in Holi celebrations and gatherings this year also.

Even though the excitement related to the festival will be diminished, but in the current scenario, staying home and keeping everyone safe is the only key currently to restrict the transmission of the deadly virus. As many of us are aware that the festival involves a lot of physical touch right from applying colours to greeting your loved ones with hugs, one cannot get away from Holi celebrations without coming in close contact with others.

Precautions to keep  safe :

Hence, during the covid-pandemic, one’s indulgence in these activities can increase the risk factor of infection for everyone. Adding to this is the inevitable involvement of water-filled balloons and pichkaris (water sprinklers). Playing with water can worsen the health condition of any person down with flu and can even cause pneumonia. Therefore, while celebrating Holi this year, it is advisable that people adhere to the following precautions to keep themselves and their families safe –

1. Maintain at least 6 feet distance from a person who is coughing or sneezing to keep oneself safe.

2. Avoid community gatherings in one’s society and nearby areas and limit the interaction with family.

3. Follow proper hand hygiene and social distancing norms while stepping out.

4. Ensure that the people visiting your house don’t have cough and cold.

5. Do not remove your mask and dispose them properly after use.

6. People who have recently returned from travel should strictly adhere to a 14-day quarantine period to restrict transmission.

7. Have enough immunity boosting foods.

Also Read: Healthy eating : Food to eat during Covid times

8. Avoid hugs and handshakes and instead greet everyone with namaste on Holi to limit physical contact.

Lastly, the public should be mindful that our efforts to bring back normalcy through increased vaccination can take a big hit because of Holi celebrations and community gatherings and hence should not get carried away with the festive cheer. It is strongly recommended that people who are above 60 years and children who are below 10 years of age with comorbidities should remain indoors and refrain themselves from participating in the festivities.

Holi is an annual event and can be celebrated next year also, however, lives lost during this time due to the covid-19 infection cannot be brought back. Therefore, ensuring the safety and security of one’s family members remains in one’s adherence to the preventive measures.

Dr. Brunda M S
Consultant – Internal Medicine
Aster CMI Hospital, Bengaluru

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An oft-repeated maxim — ‘Cleanliness is godliness’ brings out the essence and significance of personal hygiene. More so, tidiness is also an integral part of Indian culture. Initially, people used natural ingredients in the absence of modern personal care products to look attractive. However, scientific advancements have served an array of modern personal care products wherein moms and baby products have carved out its niche share in the market.

The global baby personal care market size to expand

Last year, the global baby personal care market size was valued at USD 5.67 billion and is expected to expand 6.2 %  compound annual growth rate (CAGR) for the period 2020 to 2027. The market is expected to have a healthy growth due to increasing concerns of baby health, growing alertness among customers about the personal cleanliness of babies, and the growth of the organized retail sector.

With the increasing graph of income and standard of life, people demand such personal care products which are natural and healthy. Despite the presence of  old established companies like Himalaya, Dabur, Emami and several other Ayurveda companies in this segment, a continuously expanding market is presenting equal growth opportunities to newer companies. Immensely popular new e-Commerce brands, which claim that their moms and baby care products are natural, are live examples.

e-Commerce products lack transparency in labelling and certifications:

However, the authenticity of the claims responsible for the popularity is still questionable as most of the products lack transparency in labelling and certifications. Talking about the transparency, the claims of the products the new-age companies are making and their certification, Dr Chandrakant S Pandav, Former HoD, Department of Community Health, AIIMS, New Delhi, Former President Indian Public Health Association, says, “There is a lack of transparency in the claims of the new-age e-Commerce companies as the composition of ingredients in their products contradicts their claims. To safeguard the consumers from getting fleeced and their health interests by the false claims made by these companies, we need stringent regulation and certification-mechanism in place to ensure the authenticity of the products. To this end, govt. must come up with strict guidelines and form an independent body that looks into the authenticity of the claims and certification. This grievance needs an urgent redressal.”

Observing the claims of new-age companies about their moms and baby products, Dr Manish Sharma, Hony. Consultant, Indian Medical Academy for Preventive Health (IMAPH), a premier Medical Advocacy group in the country, said, “Discerning the composition of the moms and babies products of new-age e-Commerce companies reveals that they use marketing gimmick in their claims to entice the customers. If we see the products of one of the visible brands  baby products namely — ‘deeply nourishing body wash for babies’, they broadly claim that there are no harmful chemicals and the product is natural. While Potassium Sorbate an ingredient in the product may cause skin irritation in some cases or the other.” ^{[1, 2]}

“Possibly, to market their products, increase the customer base, and multiply the sales, the new-age companies have been making such claims of their products to be natural. Regardless of chemical constituents in their products which are not scientifically verified and are claiming to be natural. But how a chemical ingredient blended product be so? Perchance, this is because of lack of proper guideline and certification processes in place”, says Dr Sharma.

Penalize such brands if they mislead consumers.

Presenting her stance on the claims and the authenticity of the products of the new-age companies, one of the doting mothers, Deepa Singh, says, “I definitely feel such brands are misleading their customers by claiming certification that is from non-accredited agencies. Most of these companies, are endorsing its product through foreign certification, which is still questionable until the claim is certified by the credible national body. Their whole marketing and the advertising strategy is based on luring customers by claiming to be natural while hiding chemical components under the names that customers are not aware of or don’t check. There should be an independent agency to look into the claims made by such companies and also the regulations to penalize such brands if they mislead consumers.

Ms Sneha, a caring mother opined, “There are so many baby products in the market which contain certain ingredients that might be harmful, but the worry is that people generally don’t know about the harm of the product and use it based on the advertisement. The use of baby products is a personal choice. I don’t use talcum powder for my children as talc is not good for the skin of the babies. As children’s skin is very delicate, so we should be very careful while choosing the products. There are chances of rashes on their skin, so the products should carry minimum chemicals in it. Generally, people don’t examine the authenticity of the product or go through the labels, but many times products carry such ingredients which may be harmful to your baby’s skin. So, every consumer needs to examine whether these proclaimed natural products are natural or not before buying.”

Penalize  brands if they mislead or mis labelling consumers.

The market is widespread with such baby merchandises of developing e-Commerce establishments, which entitle their products as natural. In the product market, every company has the right to grow, but penalize such brands if they mislead consumers. The purpose of advertisement, packaging and labelling is to increase purchaser’s vigilance on products and also give information so that they can make conversant selection. However, mis labelling for any ulterior motive must be avoided.

Moreover, customers also need to be an informed buyer. So, it should be our call to have a multidimensional scan of the products we choose before buying without relying on advertisements and labelling. The ensuing discrepancies are eventually tendering harm to us – the customers.

References:

[1] https://pubchem.ncbi.nlm.nih.gov/compound/23676745#section=Human-Toxicity-Excerpts

[2] https://onlinelibrary.wiley.com/doi/abs/10.1111/j.0105-1873.2005.0407i.x

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Public private partnerships or PPP model in healthcare scenario in India has seen a growing trend.  The aim of this article is to understand the scope of partnership of private service providers in the public health setup of Indian healthcare. We will begin with understanding the Indian healthcare scenario first.

So what is PPP model?

At a growth rate of 7.17% in GDP in the year 2017, India is one the fastest growing economies in the world. India is expected to become the world’s 3rd largest economy by the year 2050. Healthcare economics which are one the major factors in guiding the countries’ economies has seen a wide upgradation. Yet what be India’s expenditure in healthcare as a percentage of GDP is still one of the lowest as seen in figure 1.

Snapshot of the Indian healthcare system:

What is the contribution of private and public sectors in Healthcare scenario?

Public health facilities in India consists of sub-centres, primary health centres, secondary health centres and medical colleges and tertiary care centres. These institutions are mostly state or centre government funded. Out of all the spending made for healthcare, only 20% of that is against public healthcare, which is representative of approximately only 1% of the GDP – lowest amongst all the developing and developed countries. As per what is the demand of this country which is the world’s second most populated country, this contribution of public healthcare is negligible.

Demographic changes play a big role in determining the healthcare demands:

With improving health facilities and health infrastructure as compared, an increase in life expectancy is seen. If this increasing trend continues then India is to see increasing stress on the existing healthcare infrastructure.

1. Increasing population does not only haunt healthcare but also the existing socio-economic scenario of the country.

2. These changes in demographics come along with altering the disease profiles and increasing the incidence of lifestyle disease like diabetes and cardiac ailments.

3. Urban middle class accounts for the most when it comes to healthcare expenditure. With increase in the population of urban middle class population specifically the demand and consumption of quality healthcare is set to increase.

4. The demand for quality healthcare is also influenced by improved health awareness which comes with increased literacy rates. As the literacy rates are improving the need for above average quality of healthcare is also increasing.

The graph here represents how overall literacy has seen an increasing trend in the past few years.

Does Indian Healthcare infrastructure have enough capacity to fullfill the current healthcare demand?

Providing quality healthcare services are highly capital intensive. To build a secondary or a tertiary care hospital it involves no less than 25-40 lakh per installed bed. High manpower requirements ranging from highly skilled doctors to nurses, housekeeping staff, security personnel, lab technicians, front office managers as per the reports and papers published india lackhs in both capital and manpower. India lacks infrastructure so much so that according to 2017 world bank data India has only 0.7 bed per thousand population.

Some states with good economic and healthcare capacity have in excess whereas some performing below the poverty line are too less than the average as described by WHO for the low income countries i.e. 1 bed per 1000 population. To reach the minimum national average, India needs an additional 3 lakh beds. Considering a minimum of 25 lakh per bed cost, an approximate expenditure of 75,000 crore is required in healthcare. In the total healthcare cost maximum expenditure is done on setting up and running of the healthcare unit. Out of the total setting up cost of any hospital 40-65% cost is attributed to land and building.

If the project is somehow done with government support and funding then land acquisition cost is no longer a part of the project costs and the benefit of this reduced cost can be given to the beneficiaries by reducing the cost of services. Other major cost incurred is the equipment cost which is highest for the tertiary care hospitals because they import 70-80% of the equipment. Maintenance and operation of these equipment would also require skilled manpower and involvement of outside parties can also be required.

When national Health Policy 2017 was launched what advisory did it launch?

Key policy principals of NHP-2017 were:

1. Professionalism, integrity, ethics

2. Equity

3. Affordability

4. Universality

5. Patient centered and quality of care

6. Accountability

7. Inclusive partnerships

8. Pluralism

9. Decentralisation

10. Dynamism and adaptiveness

In NHP 2017, government has first time realised the need of private players to collaborate with less expensive public facilities to function to achieve universal health coverage. Govt. also proposes to help private hospitals subsidize costs for people below the poverty line.

If PPP model is implemented, then who will be the stakeholder:

1. Provider

2. Payer

3. Beneficiary

4. Regulator

5. IT infrastructure

Scope of PPP model in India:

1. Disease surveillance

2. Purchase and sitribution of drugs in wholesale

3. Contracting out specialists for high risk pregnancy cases

4. National disease control programme

5. Social marketing

6. Adoption and management of PHC’s

7. Medical education and training

8. R&D investments

9. Telemedicine

Key areas where Private players can be involved are:

1. Infrastructure and development

2. Management and operations

3. Capacity building and training

4. Financial mechanism

5. IT infrastructure development for networking and data security

6. Material management

Infrastructure and development:

Planning, designing and development of health infrastructure with innovation and strategy is the area where private partner involvement is done in the case of healthcare infrastructure. Development of infrastructure with innovation could help in bridging the resource gap. Modern healthcare facilities come at a higher price due to high investment costs and hence are still unaffordable for 90% of the population. PPP can offer a solution in this matter by providing land at subsidised costs which reduces a major part of the capital investment during infrastructure development.

Management and operations:

India has a vast health infrastructure but is under utilised due to inadequate management. Ranging from PHC’s to large tertiary health centres, poor management leads to efforts of the government go in vain. To the contrary the private sector has grown exponentially in a short period of time due to right minded management techniques. At PHC level private clinics are performing better than public facilities, due to maybe more facilities, quality of care and better hygiene. Here is where the PPP can intervene by upkeep the infrastructure, maintaining good housekeeping and supply chain, well equipped pharmacy and OPD, well functioning equipment and machineries.

Capacity building and training:

As mentioned above the inadequate management is also due to lack of required skill set in the public facilities. In this case PPP can contribute by providing adequate training to the hospital staff and building their skills set to better utilise the infrastructure and facilities in providing quality healthcare services. Public hospitals are well equipped with space, clinical material for both in-patients and out-patients. With proper training and development of nurses, auxiliary staff and housekeeping staff, these resources can be utilised judiciously. This can be a contractual work which will not require an integrated arrangement for long term, it might be required over some time intervals. Private players can be utilized for continuing education programs for the doctors and nurses.

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The world is in a chaos that none of us had even imagined. The list of unprecedented events is getting longer with every passing day. Countrywide lockdowns, tearful eyes of national leaders, crashing markets, workers trudging hundreds of kilometres in search of safety are just a few instances from that list that can give shivers to anyone. The danger posed by Covid-19 is real and so is the fear caused by it. In such desperate times, social distancing and hygiene are the new mantras of life. The entire mankind seems to be revolving around them. The resulting paranoia of this pandemic has caused us to chase ultimate standards of cleanliness in every possible way.

Scrutiny before Buying:

Once this tide of Covid-19 recedes, life will be very different from what we knew it to be and what we have lived. Some new habits developed during this crisis will stay forever and some which we had until today will fade. Forget the warm hugs with our near and dear ones, even formal gesture of shaking hands too may vanish from our daily lives. Masks, gloves, and sanitizers, which we used only occasionally may stay in our daily lives permanently. Evenings, planned to be lived with friends devouring every single roadside delicacy are already getting spent in browsing for floor cleaners and sanitizers on mobile apps.

The industry has also seen it as a golden opportunity and entire supply chain, from TV commercials to the neighbourhood grocery stores, all are teeming with a plethora of cleaning solutions. In this hunt for perfect hygiene to protect our families from the pandemic, informed by TV ads, WhatsApp forwards, and our own conscience, we are doing whatever we can. Subscribing to an entire gamut of novel sanitary products is one such endeavour. Most of such products stand by the tall claims that they make and help in keeping ourselves safe from harmful microbes. But these novel products have one more dimension that needs to be analysed carefully before giving them space in our lives.

Products can cause some side effects:

Almost each one of such products available in the market can cause some side effects. Due to intense competition and the race to connect with the target consumers, these products need to have supplementary features(like fragrance, colour, packaging etc) that differentiate them from their competitors. Many such products have succeeded to form this coveted connect with our daily routine, which appears to remain untampered in foreseeable future. But the research available on the side effects of their ingredients gives a clear sign of warning. We have already lost many lives to cancer by the time we could set in place the emission standards for telecom equipments(The Guardian, 2018). To ensure that this episode is not repeated with these chemicals, a strong vigil is required before introducing these new products in our lives.

The chemistry inside:

Undoubtedly, these easy to use products bring comfort to our lives, and thanks to the market competition, they are readily available at very reasonable prices. Convenient alternatives such as mosquito repellent coils, mats, creams, and electronic vapourizers have already kicked cumbersome mosquito nets out of many households, but we rarely care about the carcinogens and other poisonous chemicals they contain(Kohli et al, 2014). These chemicals such as Prallethrin, Cypermethrin, Diethylbenzamide etc when used in concentrated forms act as poisonous insecticides, requiring utmost precautions.

But as a part of our daily lives, even in small quantities, prolonged exposure to these chemicals may cause adverse effects on the body. We generally tend to remain ignorant of these effects owing to our hectic lifestyle. Similarly, many of us have a bias to see packaged dairy products and fruit juices as healthy alternatives, but rarely we are concerned about the flavours, preservatives, and sugars which may affect the digestive system adversely(Anand and Sati, 2017). Most of these chemicals have been introduced in our lives for merely a few decades but the rift between the scientific world and industry over their side effects is overtly evident.

Fashion or Need

At times, our shopping list contains some sanitary products just because of peer pressure, recent trends, or the TV commercials claim it to be indispensable for maintaining hygiene. But if we delve deeper into their chemical composition and their actual requirement, it won’t take us a moment to strike them off the list. The ozone generators are in fad these days. It may be the Ozone layer depletion effect, because of which many among us see Ozone as a gas beneficial to health. But the reality is entirely different. A high concentration of Ozone may cause serious damage to our respiratory system(US EPA Report).

Tall claims of fragrant floor cleaners, glass cleaners, sanitizers, vegetable washes are irrelevant, if their constituent compounds have serious repercussions when used over long terms. Few minutes of introspection is sufficient to realize that a healthy and hygienic life can be lived even without them. On the contrary, we would save our toddlers playing on the floor from harmful effects of Benzalkonium Chloride, iso Propyl Alcohol, and innumerable other volatile organic compounds(VOCs). The intensity with which cancer is prevalent these days, exposure to such novel harmful chemicals might be a dominant cause. Probably we don’t even need many such chemical-based products, but under the influence of effective marketing campaigns of national-transnational giants, many harmful chemicals manage to encroach into our life systems.

Hygiene hypothesis:

Experts in the world of medicine have hypothesized that taking precautions over a certain limit may make us more vulnerable to microbial attacks (Stiemsma et al, 2015). But there is no simple formula to determine this limit. It has to be determined with absolute dexterity, since the balance between protection from microbes and ensuring a robust immunity is a delicate one. The obsession to sanitize each and everything in the surrounding is bound to erode the immunity of any normal person, particularly for growing children(Bloomefield et al. 2006).

The frequency with which we are facing one infection after another and pandemics rocking some part of the globe almost on regular basis, it is important that we don’t end up compromising our immunity in the search of absolute hygiene. WHO has already declared antibiotic resistance crisis and an impending danger on global health, food security, and development. Given a world where new microbes are evolving at an unexpected pace, maintaining our innate immunity cannot be deemed less significant than maintaining hygiene.

What can we do?

In this era full of novel challenges, it is imperative to steer one’s vision and decisions unperturbed by impressive advertisements, fashion trends, peer pressure, and mindless consumerism. It is important to examine those chemicals which have already pilfered into our lifestyle and evaluate the extent of their possible side effects. For the families with kids, elder lies, and pregnant ladies, being vigilant about every new product is the only choice and fully examining the information given on the packaging and brochure is indispensable. The internet is a good source of certified information about many such industrial chemicals and their side effects. Consulting an expert and using these products in the right amount and in the right way is need at the moment. An eye on this other side of the coin will prepare us for the upcoming times.

Ankur Srivastava

Mob: +91-9450600839

Email: ankurs22@iimklive.com

Author Ankur Srivastava is a graduate from IIT Guwahati in Chemical Science & Technology and Master in Business Administration from IIM Kozhikode.
References:
1. www.theguardian.com/technology/2018/jul/14/mobile-phones-cancer-inconvenient-truths
2. Charu Kohli, Rajesh Kumar, G. S. Meena, M. M. Singh, Jyotiranjan Sahoo, and G. K. Ingle; Usage and Perceived Side Effects of Personal Protective Measures against Mosquitoes among Current Users in Delhi; J Parasitol Res. 2014; 2014: 628090.
3. Anand SP and Sati N: Artificial Preservatives and their harmful effects: Looking toward nature for safer alternatives. Int J Pharm Sci Res 2013: 4(7); 2496-2501. doi: 10.13040/IJPSR. 0975-8232.4(7).2496-01
4.www.epa.gov/indoor-air-quality-iaq/ozone-generators-are-sold-air cleaners
5. Leah T Stiemsma,1,2 Lisa A Reynolds,3 Stuart E Turvey,1,2,4 B Brett Finlay; The hygiene hypothesis: current perspectives and future therapies; ImmunoTargets and Therapy, Volume 2015:4 Pages 143—157
6. SF Bloomfield, R Stanwell-Smith, RWR Crevel, and J Pickup; Too clean, or not too clean: the Hygiene Hypothesis and home hygiene; Clin Exp Allergy. 2006 Apr; 36(4): 402–425.

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The nationwide lockdown has been extended again till June 30, 2020, in some cities. With the number of people getting infected and the death toll increasing every day, it is not yet certain whether the lockdown will be extended further or called off. It must be understood that our life post lockdown will not be the same as it was earlier. Corona virus outbreak has completely changed our normal pace of life and post- lockdown it will be the time for us to get along with the new normal. 

Be it lockdown or no lockdown, it is essential we adapt ourselves to our new way of life that includes

1. Wearing masks and gloves whenever we step out,

2. Carry a sanitiser wherever we go and use it to disinfect our hands,

3. Sanitise our cars and the surfaces that we touch including our mobile phones on a regular basis,

4. Wear a different set of footwear when we step out and leave it outside before we step indoors,

5. Change our clothes and wash them each time we come in from outside,

6. Wash our hands and feet when we come back home,

7. Wash and disinfect groceries, food packets or anything that get delivered from outside and

8. Maintain safe physical distance from each other.

The lockdown may be soon called off but one must ensure they maintain self-isolation as much as possible. 

Things to keep in mind while you travel:

It is advised to not make any plans for international and domestic trips for the next few months. Now that the government has decided to allow the flights to operate from May 25, 2020, here are a few guidelines that one must follow to remain safe. It must be kept in mind that one must NOT travel unless it is an emergency.

AIRWAYS:

International travel is a big NO for the next few months as it may increase the risk of spreading COVID-19. However, if the government decides to permit the airlines to conduct domestic travels and people have to step out of homes and travel within the country to meet an emergency, strict measures need to be taken to ensure social distancing and appropriate hygiene are maintained.

Measures must be taken to disinfect terminal buildings and staff and passengers must maintain adequate distance among each other once the lockdown is called off. Appointing adequate number of queuing managers at city side, check-in, security check areas and boarding gates along with social distancing signage must be made mandatory at the airports. Passengers should be asked to wear masks. Airport authorities must put signage in coloured tape and provide uneven sitting arrangements with gaps in between to make sure the passengers maintain safe distance among them. More seating arrangements must be provided in the check-in areas close to the check-in counters, immigration and security areas.

Airport premises must be cleaned thoroughly and more sanitation professionals should be deployed. Desks, chairs, railings, elevators, trolleys, handles, baggage belts, trays and more should be cleaned on a daily basis. Washrooms need to be shut and cleaned every hour. Steps should be taken to avoid overcrowding at the counters like self check-in facilities and check-in from homes. Social distancing norms and sanitisation should be maintained at lounges, food courts and shops. Facilities must be provided to isolate infected passengers at the airport and the airport staff must also be screened at the entry points. Seating arrangements inside the flight should be maintained in a way allowing adequate distance between two passengers. Also, passengers must be allowed to carry food on flights instead of serving in-flight dishes.

RAILWAYS:

In case the government decides to resume passenger services  in railways, it should be done in a phased manner and on specific approval of each train from the Railway Board. The routes of the trains must be speculated and the authority must make sure that the trains do not travel through or have halts at Covid-19 hotspots. Passenger safety must be the main focus of the authorities and steps must be taken to make sure the passengers wear masks and maintain the required distance among themselves inside the compartments to prevent spread of the deadly virus. The authority must adopt a strategy to screen every passenger before they board the train. Steps must be taken to avoid overcrowding at the stations as well.

Things to keep in mind while you visit restaurants, clubs, public toilets:

Although most of us are bored sitting within the four walls and want to head out for hanging out with friends and dear ones, it is best to not do that now and remain at home. In case the government decides to open restaurants, clubs and other public spaces in near future, one must remember to follow the safety protocols while stepping out to minimise Coronavirus risk.

Here’s how the dining experience needs to change. Waiters must wear masks and gloves; sanitisation bottles must be kept at the entrance and arrangements for fewer tables at the restaurants must be made. The restaurant staff should be trained on keeping safe distance from the diners. Adequate distance must be maintained between tables and make seating arrangements with sufficient gap between two chairs. Only families coming in groups should be allowed to share tables. A microbiologist should be on-board for swab tests of surfaces, kitchen and kitchen staff. Additional focus must be given on maintaining cleanliness and hygiene and cutlery should be kept safe in cupboards and must be taken out only at the time of the use. Steps must be taken to ensure minimal surface contact in public spaces.

Precautions to take while travelling in a cab or sharing mobility

The government has allowed the app-based aggregators to become functional and cabs and autos have started plying on roads. While it is safer to avoid stepping out as much as possible, it is essential to follow certain protocols if one has to avail a cab/auto ride or share a ride.

1. Try not to share a cab with those you do not live with.

2. Wash hands immediately before and after.

3. Carry hand sanitiser with 60% alcohol and use it regularly while you travel.

4. Carry a pack of antibacterial surface wipes to clean the surfaces you touch.

5. Wear gloves and masks.

6. Put luggage in the boot of the car.

7. Clean the door handles, gear shifter, key fob, steering wheel, external touchpoints and the dashboard.

8. Use online mode of payment instead of cash.

9. Maintain safe distance from the cabbies for both of your safety.

10. Try and keep the front seat free.

Workplace norms :

In the present situation it is best for the employees to continue working from home. However, in case the workplaces are allowed to become functional, here are certain basic things that must be maintained.

1. The company must allow its employees to work in shifts to prevent large gatherings of people in one place.

2. Surfaces like desks and tables and objects that are regularly touched need to be wiped and disinfected regularly.

3. Sanitising hand rub dispensers must be put in prominent places around the workplace and the dispensers must be refilled at regular intervals.

4. Posters promoting handwashing and respiratory hygiene must be displayed in public.

5. Face masks and paper tissues must be made available at the workplace.

6. Employees with flu-like symptoms must be given immediate leave and must be asked to remain at home.

Some essential don’ts post lockdown:

1. It is wise to not plan a vacation for the next few months immediately after the lockdown is removed. It must be realised that movement of people from one country to another resulted in the disastrous spread of Covid-19.

2. Do not give up on practicing hand hygiene. Regular and frequent washing of hands can keep not just Coronavirus but other diseases at bay as well.

3. Do not visit crowded restaurants and clubs for snacking and chilling out. It is wise to avoid large social gatherings in cafes and clubs. Also, do not organise for a house party with a large number of people coming in together. It is essential to avoid large social gatherings for the next few months.

4. Do not skip using face masks and do not give up maintaining respiratory hygiene in public places.

5. Prevention is always better than cure and it is smarter to take adequate preventive measures than to contract infection.

Dr Sachin Kumar

Senior Consultant and Head, Department of Pulmonology

Sakra World Hospital,Bengaluru-560103

https://www.sakraworldhospital.com/

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Effective primary health care is one of the purposes of sustainable development for health care outcome¹. The quality of service is the basic concern to access the effective primary healthcare. Qualified doctors and health workers are limited in rural areas of India². In rural areas health care quality mainly varies due to absenteeism of qualified government MBBS and by their replacement support system through non MBBS workers. Absenteeism of qualified government doctors and nurses is a major drawback of rural health care system.³ Two independent but related issues like weak regulations and lack of financial incentives drive the government doctors to practice in private sectors⁴. Quality of health care services in highly populated areas is quite important factor for the developing economics to provide effective health care facility.

It has been reported that utilization of government outpatient department (OPD) is only 10 to 20%⁵. Health care efforts by the practitioner are much better in private clinic than the government OPD⁶. It has also been stated that the treatment efforts are much poorer in the government sector than private hospitals. It is estimated that in rural areas of north India 45% to 80% unqualified doctors are providing health care services resulting in the substandard services and chances of disease remedy is limited compared to qualified doctor’s treatment⁷. This study aims to draw attention of policy makers towards regulation and e-public private partnership (e-PPP) to improve rural health care system.

The study is basically brought about by using secondary data obtained from published articles and reports available online. An assessment of various results, facts and reports were contemplated to represent the current scenario of rural health care in India. This analysis was taken to evaluate the opportunities and challenges in the implementation of e-PPP model on rural health care system. The scope of this finding using e-PPP model along with cloud based electronic health record system may help the government to make subtle plans to modulate the rural health care system. Rural health care system reformation and strengthening is one of the purposeful motives for overall booming of health care sector in India.

Demographic indicator in rural health care-Life expectancy is a factor to build up any health care system in the country.In India, life expectancy is 68.56 years according to the data of year 2016. Few states like Kerala, Tamilnadu have 10% more population in 60 years age group. Overall life expectancy rate is more in the rural areas than urban areas⁸. 

Socio-economic indicators in rural health care- Literacy rate determine the level of awareness about healthcare services among people in that particular area. And, the overall literacy rate in rural areas of India is 71%. Kerala (92.98%) and Mizoram (84.10%) have the highest literacy rate in rural areas. On the other hand Bihar has 59.78% of literacy rate in rural areas⁹.

Critical views on rural health care system in India:

Entire health care system comprises of the government, doctors, nurses, paramedical staff, academicians, health care financer, pharmaceutical companies and health insurance companies etc. Private health care sectors are growing rapidly. But as per the middle class and below poverty line person’s prospective, the accessibility, affordability and availability are the major challenges in India. Public sector of India only spent 1.2 % of GDP, lowest among the other countries^{10, 11}. Rural health care system is three tier system based on facility and average rural population are covered by health care facility depicted in Table 1 and Table 2 respectively¹².

Table 1: Rural health care system in India

Table 2: Average rural population covered by healthcare facility as on 2016*

According to one WHO report, India is on the 52nd position out of 57 countries facing crisis in human resource of health care division. India is having a huge short fall of general and specialized doctors, but the prominent impacts has been seen in the rural areas as more than 70% population lives in the rural areas¹².

e-PPP model in rural health care system- This partnership is basically cooperation between public sector (government) and private sector that fulfill common healthcare goals. e-PPP model in health care system may be defined as a profitable or non profitable initiative. Main aim of this model is to develop a better health care infrastructure, hassle free medical services and treatments regardless of location^{13, 14}. The e-PPP model in health care is depicted in Figure 1.

Figure 1: e-PPP model in rural health care

In case of e-PPP model, Public sector provides the existing infrastructure and contract with any third party for info-tech setup in a cost effective manner. Third party must provide effective data security. Public sector establishes the policy of the partnership and data access facility. They also provide online basic health services via tele or m-health approach and national health schemes like Ayushman Bharat or NHPS etc. Any private sector and doctors, as an individual can join this model. It is an open ended model, so no one can establish monopoly or together as oligopoly. Private sectors provide advanced diagnostic services like CT, MRI and better laboratory facility along with advanced medical services via online and offline mode.

All the sectors are linked via cloud based electronic health record (EHR) and unique id (UID) based patient data access system. Patients get the basic health care treatment regardless of their location through mobile technology. Even if, they don’t have access then they can come to any nearest centre for this technology to get general and specialized health services.  Patient can avail the public health scheme or private insurance scheme. Patients may directly pay to the doctors or sectors via unified payments interface as an instant real time payment system. Doctors can join as an individual or as a team from any sector.  They will get the service incentive quickly through this mode. The key actors of this model are depicted in Figure 2.

Proposing factors –These factors may be effective depending on further analysis of critical success factors of the e-PPP model which will define its sustainability.

Health care provider: Real time incentives encourage them to get involved in this electronic treatment approach. It also reduces the travel issues to reach to any rural sector on time.

Health care seeker: Patient can get basic and few specialized health services in their location which will be time efficient and cost effective for their disease condition. Scheme based facility is also applicable to specific scheme holders like Ayushman Bharat or National health protection scheme etc.

Public sector: Sector must strictly maintain the policy and should adequately maintain the basic technological infrastructure.

Private sector: Any private sector can join in this model but they should maintain the service rates that are same for all the sectors which are also accessible to the people.

Cloud based EHR system with e-PPP model: Inclusion of electronic health record system reduces the paperwork and introduces clarity as well as effectiveness in e-PPP model¹⁶.

This model motivates more doctors and paramedical staff to get engaged in rural area for the betterment of healthcare as well as their own career growth. The advantages of proposing e-PPP model in rural health care are mainly improvement of rural healthcare services, initiation of high-quality diagnosis and laboratory services regardless of patient-doctor location. This will also open an opportunity for rural area’s government doctors for financial incentives and further career growth through online treatment and feedback system to spread their services endlessly.

It is believed that this approach may overcome the absenteeism issues to provide effective health services continuously. It will help the overall health care system to flourish and development of digital health care initiatives for providing health care coverage to all. With the beneficial projection, this proposed e-PPP model has to overcome several challenges like data security, data access through patient card, lack of knowledge regarding online payment facility to large rural population etc. This model must attain the critical success factor and monitor the illegal or unethical activities to sustain in rural health care ecosystem.

This study suggests that e-PPP model may address the problem of absenteeism and also improve the mode of rural healthcare services. Considering the different aspects, online approach may improve their financial requisite as well as health care seeker gets better health services in remote settings. People from extremely rural areas will avail primary health care facility from specialized health care providers also via tele/m-health services. This study also recommends further survey and development of critical success factors to draw an impactful conclusion which will emphasize on introduction of e-PPP model in rural health care ecosystem in India.

References:

1. Pandey, P., Sehgal, A.R., Riboud, M., Levine, D. and Goyal, M., 2007. Informing resource-poor populations and the delivery of entitled health and social services in rural India: a cluster randomized controlled trial. Jama, 298(16), pp.1867-1875.
2. Dussault, G. and Franceschini, M.C., 2006. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Human resources for health, 4(1), p.12.
3. Banerjee, A., Deaton, A. and Duflo, E., 2004. Wealth, health, and health services in rural Rajasthan. American Economic Review, 94(2), pp.326-330.
4. Banerjee, A.V., Duflo, E. and Glennerster, R., 2008. Putting a band-aid on a corpse: incentives for nurses in the Indian public health care system. Journal of the European Economic Association, 6(2-3), pp.487-500.
5. National Sample Survey Organisation (2015). Key indicators of social consumption in India health, NSS 71st round (January to June, 2014).
6. Das, J., Holla, A., Das, V., Mohanan, M., Tabak, D. and Chan, B., 2012. In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps. Health affairs, 31(12), pp.2774-2784.
7. Holla, A., Das, J., Mohpal, A. and Muralidharan, K., 2015. Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India(No. id: 7219).
8. Asaria, M., Mazumdar, S., Chowdhury, S., Mazumdar, P., Mukhopadhyay, A. and Gupta, I., 2019. Socioeconomic inequality in life expectancy in India. BMJ global health, 4(3), p.e001445.
9. ET Report, Literacy rate at 71% in rural India, 86% in urban: Survey by  NSSO (2015) //economictimes.indiatimes.com/articleshow/47886609.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
10. Planning Commission of India. High level expert group report on universal health coverage for India.2011
11. Ministry of Health and family welfare, GoI. 2016. http://www.mohfw.nic.in.
12. IOSR Journal of Nursing and Health Science (IOSR-JNHS) e- ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 7, Issue 4 Ver. VIII (Jul.-Aug. 2018), PP 25-33
13. Virani, A. and Ramesh, M., 2019. 5. How neglecting policy mechanisms can lead to policy failure: insights from public–private partnerships in India’s health sector. Making Policies Work: First-and Second-Order Mechanisms in Policy Design, pp.76-95.
14. Rao, K.D., Bhatnagar, A., Berman, P., Saran, I. and Raha, S., 2009. India’s health workforce: size, composition and distribution. India health beat, 1(3), pp.1-4.
15. Fabre, A. and Straub, S., 2019. The Economic Impact of public private partnerships (PPPs) in Infrastructure, Health and Education: A Review(No. 19-986). Toulouse School of Economics (TSE).
16. Anurag Dubey, Implementing EMR- Are Indian Hospitals ready? eHealth magazine March 2008. http://www.ehealth.eletsonline.com

Imon Chakraborty
PhD Research Scholar
UQ-IITD Academy of Research
Indian Institute of Technology, Delhi
Mob: 825039898
Email: imon.chakraborty@uqidar.iitd.ac.in 

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How to avoid head injury? Following certain preventive measures like wearing a helmet, avoiding rash driving and adhering to traffic rules.

A majority of the head injuries cases are preventable. Around 85% of the head injury cases are owing to road traffic accident which is avoidable. The other common causes are fall from height, accident at workplace and assault. Head injuries can range from mild to fatal.

Even in case of fatal injuries most of the patients can be saved if the treatment is started within 1 hour of the incident calling for alertness and timely action even by bystanders.

Some of the ways one could help a person who has had a head injury is by moving him/ her away from dangerous location (like fire, middle of the road etc), calling for help and shifting them to a hospital as early as possible. Though timely action may be able to save many, avoiding or prevention is always a better option.

Following certain preventive measures like wearing a helmet while riding, avoiding rash driving or ensuring adherence to traffic rules and driving safely as well as calling for help whenever an accident is spotted can go a long way in preventing casualties owing to head injury.

About Narayana Health:

Narayana Health is headquartered in Bengaluru, India, and operates a network of hospitals across the country, with a particularly strong presence in the southern state of Karnataka and eastern India, as well as an emerging presence in northern, western and central India. Their first facility was established in Bengaluru with approximately 225 operational beds and they have since grown to 22 hospitals, 6 heart centres, 19 primary care facilities across India and an international hospital in the Cayman Islands. They believe that the “Narayana Health” brand is strongly associated with their mission to deliver high-quality, affordable healthcare services to the broader population by leveraging economies of scale, skilled doctors, and an efficient business model.

Dr Vishwas H V
Consultant – Department of Neurosurgery
Narayana Health City
Bangalore

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Addiction

Addiction refers to a craving habit or a compulsion to have a certain experience repeatedly.  Addiction may be caused by a substance or an activity (Eg, digital experience, sex and gambling).  Addiction creates an altered behaviour due to craving for the substance or experience.  Behaviour gets directed by the substance or craving-causing experiences.  For instance, alcoholism is a horrific substance abuse addiction problem, which causes deterioration of physical health, mental disturbance and social problems.

Addiction is a major source of unhealthy status in society.  Addiction causes weakness in individuals, family collapse, social problems and economic loss.  Drug addiction to morphine and other Opioids, and Nicotine is defined as a chronic recurrent brain disease that seriously damages health and causes enormous social problems.  A major challenge of addiction management is relapse.  The addicted person gives up the source of addiction for some time, however, reverts to it after a gap.  It is a pattern observed in alcoholics, nicotine abusers, drug addicts and digital addicts too.

Digital addiction is a 21^st century phenomenon.  The term digital addict refers to a person who compulsively uses digital technology. The digital addict compulsively and excessively uses digital technology and is absorbed to such an extent that it is prioritized above everything else, even if it causes harm to the individual.  As with all forms of addiction, digital addiction is a chronic disease based on brain reward, motivation, and memory.

Manifestations of digital addiction

Electronic Dope – Era of new diseases. Today, digital technology is a baby sitter! The digital addict starts to form early, when playing the smartphone to calm the infant or child, distract the child to help in the feeding process, or to keep the child occupied so that the mother can continue with her facebook or whatsapp activity!!

Online gaming is a wholly absorbing child or teen habit, which consumes significant sleep time too.  This wrecks the faculty of concentration, sports habit and academic study habit in the child.  It leads to significant parental tension and verbal abuse in families.

Excessive social media activity creates nocturnal habits, eye strain and sedentary lifestyle in children and adults alike.  The soap operas on TV created a generation of idiot box addicts, and the digital screen is creating a new breed of e-morons.  Digital screen time activity particularly the gaming and interactive form, provides a dopamine boost increasing the digital dependence.  Dopamine is a brain chemical, that causes a person to feel-good and evokes feeling of euphoria and happiness.  Performing activities through the digital screen (social media or gaming) boosts dopamine release.

Many forms of digital addiction

• Nomophobia: Fear of being without your phone
• FOMO: Fear of missing out (want to read and share it first)
• IGD: Internet Gaming Disorder (playing internet games like Candy Crush for hours together)
• IAD: Internet Addiction Disorder
• Selfitis: Obsessively clicking selfies (clicking more than 5 selfies per day)
• SMA: Social Media Addiction
• Phantom Vibration Syndrome: Fven though phone is not with you, it appears to you that the phone is vibrating or ringing
• FAD: Facebook Addiction Disorder, obsessively posting photos of yourself on facebook and waiting for likes and responses.

The digital addict suffers addiction just as any other form of addiction.  He or she needs help and support to get rid of the electronic dope from his or her life.  Several institutions now treat digital or mobile phone addiction, including NIMHANS: National Institute of Mental Health and Neurosciences, Bangalore.  NIMHANS Center for Well-Being http://www.nimhans.ac.in/nimhans-centre-well-being/services offers counseling and other services for treating digital technology addiction.

Sunil S Chiplunkar
M Pharm (Pharmacology) MBA (Marketing) PGDHRM
VP – Training (Marketing)
Juggat Pharma:
Pharma division of Jagdale Ind. Pvt. Ltd.,
Bangalore – 560078
sunilchiplunkar@gmail.com
Ph.: 9379077788
www.pharmaceuticalshealthcare.blogspot.in

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2. More than 6 million global deaths are the result of direct tobacco use while around 890 000 are the result of non-smokers being exposed to second-hand smoke. Of the more than 6 million tobacco-related deaths every year across the world, one- sixth occur in India alone.

3. Total tobacco-related deaths are expected to reach 8 million by 2030. The Global Youth Tobacco Survey (GYTS) estimates doubling of deaths from smoking because of the increase in smoking among young girls compared with adult females, the high susceptibility of smoking among never smokers, high levels of exposure to second hand smoke, and pro-tobacco indirect advertising.

4. Around 80% of the world’s 1.1 billion smokers live in low-and middle income countries.

Second hand smoke (passive smoking) is the exposure of non-smokers to smoke that fills restaurants, offices or other enclosed spaces from tobacco products – cigarettes, Bidis and water pipes. About 34,000 non-smokers die from heart disease each year from exposure to second hand tobacco smoke in USA and is a leading cause of heart disease in non-smokers, your children, partner and friends.

1. In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer.

2. In pregnant women there is a high risk of complications during delivery. it causes low birth weight of the new-born babies. Infants have higher risk for sudden infant death syndrome (SIDS).

3. Almost half of children regularly breathe air polluted by tobacco smoke in public places. In 2004, children accounted for 28% of the deaths attributable to second-hand smoke. Children exposed to tobacco smoke are more likely to have ear infections and asthma.

4. Second-hand smoke causes more than 890 000 premature deaths per year.

Third hand smoke is residual nicotine and other chemicals left on indoor surfaces by tobacco smoke. People are exposed to the chemicals by touching contaminated surfaces or breathing in the off gassing from these surfaces.

Dr.N.Mariappan

Plastic surgeon, Chennai

Ph: 9901043568

E-mail: drn_m@hotmail.com

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