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Contrarian views on coronavirus

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Here's a collection of some of my LinkedIn Posts on the Coronavirus Pandemic.

I don't claim to be an expert - but do try to think logically as a doctor, and use my common sense to reason !

Published in: Health & Medicine
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Contrarian views on coronavirus

  1. 1. Contrarian Views on Coronavirus - Dr. Aniruddha Malpani ~Collection of all LinkedIn posts Opinions The Coronavirus Pandemic has brought into sharp focus how intolerant we are of people whose opinion is different from ours! Many of my friends wonder why I stick my neck out by expressing contrarian views about the Coronavirus Pandemic, which are unpopular, and attract trolls. Do I enjoy raising controversy? Fortunately for me, I do not have to worry about being politically correct or toeing the party line, so I am happy to share what is on my mind on a public platform. I don't pretend to have all the answers, and am happy to be proven wrong if this done logically and politely! I am happy when people don't agree with me about the Coronavirus Pandemic - this reassures me that I am on the right track! Madness is rare in individuals - but in groups, parties, nations, and ages it is the rule. - Friedrich Nietzsche' The madness of the crowds has destroyed the wisdom of the crowd in the Coronavirus Pandemic. The one thing which has spread exponentially during this Coronavirus epidemic is negativity, doom, and gloom, thanks to the media and social media! Why have we lost our ability to think rationally? Think!!! There's a lot of confusion about the Coronavirus Pandemic. There is a lot of uncertainty, and it's hard to know who to trust. This is why critical thinking skills are so valuable. Whenever you read an article, always ask your self - What is missing? What did the author leave out? And why? Sadly, most stories aren't balanced or honest. The public prefers listening to people who project confidence, even if they are ignorant. This is why the voice of thoughtful experts is never heard - they have the intelligence and humility to qualify their statements because they don't pretend to be omniscient! The slippery slope fallacy has hijacked our ability to think clearly about the Coronavirus. Berkson's bias is one of the reasons why we are over-reacting to the Coronavirus Pandemic The way we have mishandled the Coronavirus Pandemic is a great example of ● How the media misleads us ● How unreliable social media is ● Why we can't always trust the self-important talking heads ● How we behave like a mindless mob when we are scared ● Why we need to learn to respect doctors and nurses!
  2. 2. Can we please stop treating Coronavirus Positive cases as pariahs or lepers, please? They aren't ticking time bombs which are going to kill all of us! The one thing which the Coronavirus Pandemic seems to have damaged is our Common sense. We need to learn from the doctors and nurses who are routinely taking care of sick patients with COVID-19, that as long as we follow Universal Precautions, we are safe! If none of the health care workers who treated patients with COVID-19 got infected, doesn't this mean that the chances of acquiring infection because of casual contact in the community must be very low? I understand the natural tendency on everyone's part to overreact during the Coronavirus Pandemic. After all, death is scary, and no one wants to take any chances with the lives of their loved ones. However, over-reacting, over-testing and over-treating is not a risk-free course of action either! Complex adaptive systems such as the Coronavirus Pandemic are full of unknown unknowns, and the sooner we acknowledge this, the better! Rather than look for oversimplified answers, we need to learn to ask thoughtful questions! Is it possible to acquire herd immunity against Coronavirus, even without direct exposure to the virus? Yes, thanks to evolution, our immune system has adapted intelligently over thousands of millennia, so that most healthy people can fight off completely new pathogens successfully on their own. Read more about innate immunity at https://lnkd.in/fNNKS2F Our mucosal immune system protects us from invaders. And don't forget we have protective antibodies against tons of microbes, and most of these infections are silent and asymptomatic. Healthcare Workers The reason doctors make irrational decisions during the Coronavirus Pandemic ● Sometimes, clinical ritualism is “de rigueur”. ● Sometimes, decisions are dictated by the defensive practice of medicine. Physicians may wish to avoid lawsuits. They may also “over- immunize" ● Something must be done often rules. There is the art of doing nothing and the art of waiting. An old surgical saying holds that “it takes two years to get into the abdomen and twenty years to learn to stay out.” ● Sometimes decisions are made without taking into account epidemiological information and methods. ● Politically motivated decisions leave them helpless, and they are forced to toe the line ● Some decisions are dictated by extraneous power and/or justified socially, historically, culturally, or by faith. ● Simple blind willingness to please decisions are still made. Anything that pleases the patient, the physician, and/or the onlookers or any parties connected to the patient may take precedence over rational decision making. From the book, 'A Primer on Clinical Experience in Medicine' by Milos Jenicek Coronavirus Paranoia! Refusing to allow doctors to get back to their homes after their hospital duty! Mismanaging doctors and hospitals during this Coronavirus Pandemic.
  3. 3. A thoughtful article by Dr. Zarir Udwadia. 'Casually exposed medical staff should not be self-quarantined: A paper from Singapore is informative: 41 health care workers were exposed for 4 days to a critically ill patient before he was eventually diagnosed with COVID-19 infection. Despite the high-risk nature of the exposures, including intubation, ventilation, and regular intensive care, none of the workers became infected. 85% of these exposed workers had used only surgical masks (not N-95). All had however adhered to proper hand hygiene. Medical staff who have had a brief, incidental contact should only be asked to monitor themselves for symptoms. Contrast this with the recent panic in Mumbai when a large hospital was shut down after it was detected that an asymptomatic doctor and another out-patient who had a CT scan in the radiology department of the hospital had both tested positive. If health care workers are quarantined after even casual exposure and hospitals shut down, there will be no one left to treat patients!' In times of crisis, we want certainty and confidence that the authorities are in control. Sadly, it's exactly at these times, that life is going to be full of risk and uncertainty. A doctor's dilemma during the Coronavirus Pandemic - 'As an ordinary private medical practitioner with my own small set up, I feel the most lost out in the present scenario. It's not that I don't want to rise to the occasion but is there someone who will unambiguously guide me with dos and don't, what I am left with is only Farmans being issued every few hours by govt or the association who consider the entire fraternity as having the same resources as a big hospital. I am told to which mask to wear when but no one tells me where to get it from and the one which I got is indeed the standardized or just a remake by some scrupulous manufacturers who don't want to miss an opportunity to make hay while this sun is shining. There are posts after posts on PPE and everyone displaying their skills in innovating another without anyone assuring which is the best scientifically suited for the present condition. There are guidelines on prophylaxis which do not say that all healthcare personnel irrespective should take it .what does ICMR mean when it writes if you have come in contact with a suspect. Can someone tell me who is not a suspect? ' Lockdown When is the risk of continuing with the lockdown going to exceed the reward? And how do we monitor this tipping point? I hope we don't end up creating a man-made famine in our efforts to contain the Coronavirus epidemic through a Lockdown! Supply chains have got disrupted and restoring them can be a monumental task if we fail to prioritize this. The one thing which is going to grow exponentially about the Coronavirus Pandemic is the harm the lockdown will cause! Effective vs Efficient. Yes, the Lockdown is effective in reducing the spread of the Coronavirus. The problem is that it is not efficient. The cost of implementation is far more than the benefit. Most people don't seem to understand the difference. Are Lockdowns are the best way to implement social distancing to control the Coronavirus Pandemic in all areas? This is a reasonable hypothesis but should have been tested. Yes, it sounds logical, like most conjectures do, but this doesn't mean that it is right. Sadly, it has now become an unfalsifiable proposition we can no longer even express doubt in
  4. 4. The reason we are stuck with this Lockdown is because of the 'sunk cost' fallacy! I hope the Lockdown doesn't end up becoming a Chakravyuha! The Coronavirus quandary. We need to weigh all the following, and there will always be a trade-off. We need to acknowledge the pros and cons explicitly, rather than naively assume that we are doing our best! ● Personal safety ● Personal harm ● Social safety ● Social harm The risk-benefit curves of both the Coronavirus epidemic and the Lockdown are changing all the time and we need to be willing to calibrate our actions accordingly. We think that staying at home is staying safe, but this, not a cost-free option. It may provide personal safety, but can cause social harm for the poor and unemployed. The lockdown is an irrational kind of rationality because it underestimates the impact of everything which can't be measured easily, such as the long-term costs of disrupting the economy. We are trading the high risk of long-term pain by instituting unproven measures to achieve possible short-term gains. The standard justification for every extreme measure the Government takes during the Coronavirus Pandemic is - ' Desperate times call for desperate measures'. But are we responsible for creating this aura of desperation by highlighting all the negatives and amplifying the fear and panic? The Coronavirus is not going to be the last Pandemic we will see. The good news is that just like viruses evolve, so does our immune system, and it's this co-evolutionary balance that will ensure human survival - not curfews and lockdowns! Media How the media creates fear and panic about the Coronavirus. Images like this trigger a fight or flight response, and logical thinking go for a toss
  5. 5. Finagle’s laws of information, as applied to the Coronavirus Pandemic ● the information you have is not what you want. ● the information you want is not what you need. ● the information you need is not what you can obtain. ● the information you can obtain costs more than you want to pay. Please remember this the next time you read an article on COVID-19! The Coronavirus Pandemic has made the Us vs Them divide very clear propagated by media. We are happy to assume that poor people are illiterate and ignorant, and will spread the virus because they are too stupid to take appropriate precautions! Isn't this the height of arrogance? They are much street smarter than we are! The problem with the news channels is that they will never express any doubts, or offer an alternative perspective because Doom and Gloom sell far more than rational logic! We can't even agree on the definition of a Coronavirus case! In China, people who test positive for the virus but don’t have any symptoms are not classified as confirmed cases. This runs counter to the practice in countries like South Korea, Japan, and Singapore, where all patients who test positive are included in official tallies of total cases, regardless of whether they have symptoms such as a fever or cough The reason we are panicking about the Coronavirus Pandemic is that the media has dumbed us down. Most people just want to watch videos, read the gory headlines, or listen to talking heads. They need someone to explain the gist of an article to them, because they don't want to take the time and trouble to read the original, or understand the raw data, and how this has been analyzed. They first make up their mind, depending upon which story appeals the most to them, and then close their brain to alternative perspectives.
  6. 6. Technology We are seeing an epidemic of Coronavirus chatbots and apps. Most of these are copies of each other. Is this our idea of creativity and innovation? Self-isolation works for everyone. If you are sick, it stops you from infecting others. If you are healthy, it stops others from infecting you. Common sense � Why do we need to waste money on tests and apps to implement this? Big Brother is watching you - the ultimate dystopian nightmare is coming true! The privacy as we know is changing and will have a permanent effect on our lives post this pandemic. In our rush to battle the Coronavirus Pandemic, we are going to end up wasting lots of resources on useless tests, unreliable ventilators, ineffective masks, and pointless apps. Should we stop and take stock and then use it in the most optimum way? Myth Busters Masks and the Coronavirus. They have a powerfulplacebo effect in making people feel protected, even though this is an illusion! The oversimplified story is - If you get the virus, you are doomed to die! Fortunately, this false! The question we should be asking about the Coronavirus epidemic. How many healthy people would we need to quarantine and for how long, in order to prevent one death because of COVID-19? We need to differentiate mortality vs lethality when discussing Coronavirus Deaths! The problem with the Coronavirus epidemic is that people confuse risk with prognosis! The risk of getting the infection is high, as is true of most viral infections. However, much more importantly, the prognosis is excellent, and the chances of a full recovery without any treatment are very high as well! Before assuming that 'tests, tests and more tests' is the best way to tackle this Coronavirus Pandemic, please try to understand the limits of medical tests. And if you can't, then please don't mindlessly ask for tests!
  7. 7. Why mass Coronavirus testing is a bad idea. It's much cheaper and easier to advise people to self-isolate! Testing is expensive, consumes resources, and increases the risk of disease transmission because many people need to go to a lab to get tested, and crowding can be dangerous! To add insult to injury, the RT PCR tests are untested because their clinical significance has not been validated! Who decides what the right LOD (Limit of Detection) should be? And has this been correlated with the gold standard - viral culture? In times of crisis, most people are happy to follow the crowd. Being part of the herd seems to be a much safer bet, rather than trying to think independently or reason from first principles The real-life problems with Coronavirus testing! Manufacturers and labs are cutting corners in their rush to go to the market and make money! The problem with the Coronavirus Pandemic is that we are confusing screening tests with diagnostic tests! Pointless testing causes more harm than good - especially when people don't know how to interpret the results intelligently! Why is everyone panicking about this? We are all going to test positive for some virus or the other! A positive test does not mean that you are going to get ill! Some Coronavirus Basics ● Positive test = Case only! ● Case ≠ Patient ● Patient ≠ Death! Interestingly, the Chinese don't count someone who has tested positive but is asymptomatic in their statistics. Labeling someone a patient on the basis of a positive test result, even though he is hale and hearty, is something which only modern medicine does!
  8. 8. Extrapolating from the Italy experience with Coronavirus to India is flawed. We can't compare apples and oranges when discussing disease transmission in a population that is so different from ours! Coronavirus - Biology vs Chemistry The infectivity of the virus is a function of the amount of viral load you are exposed to. This is why casual contact - community transmission - is very rare because our bodies can fight off small loads. The Coronavirus RT PCR tests, on the other hand, will be positive, even if there are a few molecules of the viral RNA in the test sample! We are worried that we may get infected by an asymptomatic carrier of the Coronavirus. Common sense will tell us that the risk is much less because someone who is asymptomatic is likely to have a much smaller viral load, which means he is shedding much less virus and is not going to be as infective as it is someone who is ill! Why the Coronavirus death rates are misleading? Let's take a critically ill patient in the ICU who is on a ventilator because of a stroke, with a high chance of dying because of severe brain damage. Now suppose he dies, and his Coronavirus test comes back positive. Because of the media coverage, his death will be considered to be a COVID-19 death, but the truth is that he did not die because of the virus - he did with it. It's quite possible that his respiratory tract was colonized with many other bugs as well, but because these were not tested for, these were undocumented, and therefore were not reported as a cause of death on the death certificate!

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