August 2020

Dear Members,
Seasons Greetings,

With unlock 3.0, the people have relaxed, winter is approaching when a new wave is expected. We have seen that
summer had no effect on the number of cases.
There are six strains of the coronavirus: L strain (original strain in Wuhan), strains S, V, G, GR, and GH. Strain G and its
related strains GR and GH are the most common. In North America, the most widespread strain is GH, while in South
America we find the GR strain more frequently. In Asia, where the Wuhan L strain initially appeared, the spread of strains G,
GH and GR is increasing. Globally, strains G, GH and GR are constantly increasing. Strain S can be found in some restricted
areas in the US and Spain. The L and V strains are gradually disappearing (Science Daily). Up to 30% of
additions/substitution can occur in the same strain. If the virus undergoes 70% mutation, it becomes a new virus.When we
define a surge, we should consider few points: Is it a new mutation? Is it a new strain? How does a virus behave? Is it a
superspreader? The surge can be due to a new virus, same virus but mutated and same virus but local spread
(superspreader, Dharavi). If surge is due to a new strain, the mortality may be different and higher initially. If it is a surge in
existing strain, then spread will be high, but mortality will be low.

RT PCR detects viral antigens (E, S, M, ORF, NS, RDRP); if e antigen is negative, no corona. All labs do not test for all
antigens. If the kits test for multiple antigens, the sensitivity of the test is higher. This will reduce the chances of false
negative result. Cohort pooled Ct value high, this means that the virus is getting attenuated. Ct value cannot be the only
basis of the report (ICMR), it has to be combined with clinical interpretation; Ct value can change according to the kit used;
it may be operator dependent. The cut-off value must also be mentioned. It is important for clinicians to know the viral
load. Family cluster may have varied symptoms. But, people are not coming forward. Prevention is very important, but it is
not 100% preventable; our concern is to also reduce the mortality. All efforts today are towards reducing the infection and
less effort in reducing the mortality.

Western models will not work in India. We should learn from each other about things that are unique to India.It is
important to identify Day 1. CT scan can become positive on Day 3. If RT PCR report is not available or it may be false
positive, then CT becomes important. Don’t wait for day 5, as complications may set in by this time. One must act on day 3.

Since couple of days in Ahmedabad and Surat and few other parts of Gujarat cases of covid-19 are decreasing . Easily
patients get Hospital admission as well as necessary medicines and injections. Mortality rate in public is around two to
three percents. Till now at all India level more than 20 lacs people suffered from covid-19 and there are 43,000 death
amongst them. At all India 1500 doctors are affected with covid-19 and we lost 200 doctors. So death ratio is more than
10% among medical fraternity. This is a alarming situation. More than 75% of doctors are above the age of 50 years , and
more than 50% members are general practitioners. So we should analyse this situations.
Few points which are observed are the viral load and more contact time. Doctors are constantly exposed to patients so
viral load is more. The patients like to spend more time with the doctor so more contact time in a small cabin also lead to
more infection. Overburden, insufficient sleep, insufficient rest, irregular in food, anxiety and stress lead to lack of
Nutrition, lack of resistance power and more vulnerable for infection. Comorbid conditions diabetes, blood pressure ,self
medication overconfidence, delay in getting attention may also contribute to this condition. We wish that all the private
practitioners must be taking all precautions to avoid any infection. To solve this issue doctors above the age of 60 years,
doctors above the age of 50 years with comorbid condition must stop the practice.
Long Live IMA, Jai IMA

For more information download Bulletin PDF