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Doctor In India: Emergency Room Is So Crowded, ‘It’s Nearly Impossible To Walk’



COVID-19 patients in the emergency ward of an unidentified hospital on Monday in New Delhi. Dr. Sumit Ray, a hospital critical care chief in the city, says India’s health care system is collapsing. Rebecca Conway/Getty Images hide caption

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Rebecca Conway/Getty Images

India has been setting daily records for positive coronavirus tests — more than 400,000 people on Wednesday alone.

In New Delhi, the Holy Family Hospital is at 140% capacity.

“It’s nearly impossible to walk sometimes in the [emergency room],” said Dr. Sumit Ray, the hospital’s critical care chief. “Sometimes we have to keep the patient in the ER for hours, for a day or two, because we don’t have a bed in the wards or in the [intensive care unit].”

“Many of the public areas, some corridors, etc., have been cordoned off right next to my office behind a wall,” he said in an interview with NPR’s Morning Edition. “There is about 30 patients in a common area, which used to be the outpatient department. We have used those rooms also and put beds there, monitors there, oxygen cylinders there.”

“Individual hospitals are standing up and doing the best they could. But as a system in different parts of the country, we have collapsed,” he said.

Below are highlights of the interview, edited for length and clarity.

On his hospital’s shortage of ventilators and ICU beds

Our staff is stretched. They’re working more hours, working harder, longer. … We need more ventilators because as the timeline of COVID is such that once the peak of number of cases happens about two to three weeks down the line, a certain percentage of those patients become sicker and end up in the ICU. And that’s what exactly we are seeing now. And the number of deaths are increasing now. And what we are now having a problem with is that we have many patients who need ICU beds, but we do not have ICU beds for them. So we are managing them in high-dependency units, on wards, etc. Obviously, the quality of care is not the same because the level of monitoring, etc., cannot be managed as it is needed in the ICU.

So these are the problems which we face now. We kind of predicted this a few weeks back because we know the timeline, how COVID behaves. And we had tried to tell the government that there has to be a surge capacity building so that patients who will need this may have to be shifted. And that cannot be organized by an individual hospital. It has to be built by the government. It’s starting to happen, but it’s not come through yet.

On how hospital staff are worried about COVID’s impact on their own families even as they treat patients

While taking care of patients in the hospital, we are talking to family, messaging them what to do at home when they’re down with COVID. And if they worsen, then where do they need to go? So actually, the situation has reached such a point that many of our staff are scared that even if their loved one becomes seriously ill with COVID, will they find a bed in our own hospital or any other hospital for that matter?

On how India misjudged the pandemic and what led to vaccine hesitancy

We celebrated too early, too much chest-thumping, saying that we had vanquished the virus. I think all of us underestimated the virus. But how we were proved wrong, we are paying for it. … There was a vaccine hesitancy, the reasons being that there was some degree of data intransparency, if I may say, about the vaccines that were being used in India … . So the hesitancy was partly expected, could have been done better in terms of giving more transparent data.

On the ER being far over capacity

Our ER is beyond [capacity]. It had 30 beds and we have at any point of time about 100-odd patients and there are patients sitting in chairs who are being given oxygen because we are not refusing. It’s nearly impossible to walk sometimes in the ER. … sometimes we have to keep the patient in the ER for hours, for a day or two, because we don’t have a bed in the wards or in the ICU.

On the collapse of India’s health care system

We have collapsed in a sense. I mean, individual hospitals are standing up and doing the best they could. But as a system in different parts of the country, we have collapsed. I mean, what would you say if people start dying in ambulances because they can’t get in a hospital bed, if people die at home, if people die in the ER because there is no bed in the wards or in the ICU. So that is a collapse of the system. There’s so many more deaths that could have been prevented.

Ziad Buchh, Lisa Weiner and Scott Saloway produced and edited the audio version of this story. Avie Schneider produced for the web.

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Entrepreneurship in the Age of Pandemic




As the Coronavirus still rages on, entrepreneurs have long accepted the new reality – this virus is not only responsible for a huge health crisis affecting billions of people, it has also triggered a devastating downturn in the global economy.  

The numbers are pretty depressing. According to the IMF’s April 2021 World Economic Outlook Report, the global economy contracted by 3.5 percent in 2020, a 7 percent decline from the October 2019 forecast of 3.4 percent growth.

Even if the situation looks beyond grim, entrepreneurs have to find a way to make things work. In a time when most people avoid risk, entrepreneurs must respond to change by shifting gears instead of looking like a deer caught in headlights. They need to look for opportunities instead of roadblocks. 

But that’s easier said than done. How can one succeed or even survive as an entrepreneur when most people are getting laid off? 

The key lies in remembering that every crisis has an endpoint. That’s the cue for entrepreneurs to take on something new. 

They have to take this opportunity to innovate. Businesses can increase customer touchpoints by implementing more digitalization and disruption into their business models.  

Drawing Comparison to the Past

COVID-19 may be unprecedented in its nature, but it’s not the first pandemic to wreak havoc among humans. 

Infectious diseases have decimated human societies since ancient times. And the public response has largely been the same whenever one pops up – despair and chaos caused by traumatic shock.

The frantic atmosphere was largely due to a lack of knowledge about the diseases. People were scared and wanted the certainty of expert knowledge, which was scarce. One can hardly do business in an environment like that. You would be lucky to just come out of it unscathed. 

However, things are very different this time. Humans have made significant advances in medicine, science, and technology since the last major pandemic. We knew very early how COVID-19 was transmitted from person to person, had quantified how contagious the disease actually was, and knew what the best practices would be to minimize deaths and infections. 

Hence, entrepreneurs, this time know exactly what they can and cannot do. Their scope and capabilities might be limited, but entrepreneurs can still look for lucrative opportunities for themselves. The situation isn’t nearly as hopeless as it’s made out to be, especially when compared with previous pandemics.

Going Digital 

If the pandemic has taught us anything, it’s that companies that do not digitally transform will fail. 

You must have wondered why some companies are doing better than others in this crisis. The answer to this question can be found by closely examining these successful pandemic businesses: all of them have successfully adopted digital transformation and platform-based business models.  

The business world has always been about survival of the fittest. In this day and age, companies that don’t adopt digitalization will sooner or later cease to exist. 

For example, just take a look at the wholesale industry. The COVID-19 outbreak in 2020 massively restrained the wholesale market as trade restrictions and lockdowns across the globe disrupted supply chains and caused a decline in consumption. The overall impact would have been less devastating if these companies had started doing business on an online wholesale marketplace.

Reassessing Strategy 

As the pandemic swept through the globe, most business operations came to a grinding halt. Many plans were delayed or overthrown, resulting in various business milestones being set aside.  

So what should one do? Pack their bags and just leave? Well, not so fast. This is the perfect opportunity to spend more time on developing your operational plans and improving relationships with your peers, investors, and customers. It will help optimize your business plans and take care of all the chinks in the armor.  

Look at what impact the pandemic will have on your business and industry in the coming few years. Determine whether your impact goals and ambitions are still valid. If not, you’ve now got time to make significant changes to your business timeline and strategies.   

Managing Your Assets

This is a basic reminder, but a business needs at least three assets to become profitable and sustainable: money, expertise, and people.


As they used to say, “Shoot for the stars. If you miss, you’ll still be able to land on the moon”.  

This is also true for the current situation. Aim to make a profit. If you miss, you’ll still be able to survive. In this way, you’ll manage to stay afloat and also prepare for the time when the crisis ends. 

Here are three actions you should take when it comes to money:

Action 1: Self-reflect

You need to accept that your original business plan is out of date and then plan accordingly.

Ask yourself:

  • What was your situation at the beginning of 2020? Was your business healthy or not, and why?
  • Where do you see yourself in Q3 or Q4 of 2021?
  • Approximately what amount of money do you have in cash today?
  • How much money do you need to stay afloat for the next 18 months? 

Action 2: Save Cash

Cash is king. It is time to reduce your cash burn rate by cutting non-essential expenses. Your business needs to become more agile by transforming fixed costs into variable costs. 

Reduce marketing and events expenses; eliminate everything that isn’t completely necessary to the company’s daily operations.

Identify and manage your revenue sources. Examine your customers and identify which ones might be unable to pay their invoices. If possible, encourage your clients to pay faster.

Action 3: Get Access to Capital

Evaluate and calculate the potential risks. Also, verify with your investors, partners, banker, and trusted relationships whether they are willing to support you during this crisis period; and for how long. 

Make sure you have the funds necessary to keep your company alive over the next 18 months. However, do keep in mind that video conferencing doesn’t seem to be a very effective method of fundraising at the moment. After all, establishing trust and confidence behind a computer screen is not easy.


Utilize this opportunity to strengthen your fundamentals.

Your Product

During this period, your technical teams can dig deeper and continue improving your product. Also, take this opportunity to train them in new software.

The Executive Team

Use this opportunity to improve your product fit. How do you really bring value to your customers? CEOs and executives need to think strategically since right now, they are not slaves to short-term figures and quarterly turnover reports. Take a step back and consider adjusting your strategy and putting new processes in place.

The Sales and Marketing Teams

Communicate and innovate with your most valuable customers. Understand what makes them love your product as well as what might make them leave. 

Do an in-depth analysis of your customer database. Identify missing product features: have you got the time to implement them and make your product or service tenfold better?


Your employees must continue to show their commitment if everyone wants to get out of this crisis relatively unscathed. 

Here, communication is vital. You should communicate more with your employees and try to reduce uncertainty to keep their morale high. Be sure to look after them, protect them, and ensure their health and safety. It is imperative that you are honest and upfront with your team about what you know and don’t know.


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Norovirus: Is it more dangerous than Coronavirus?



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The Lambda Variant: What You Should Know And Why Experts Say Not To Panic



A medical assistant administers a coronavirus test last week in Los Angeles. COVID-19 cases are on the rise as the highly transmissible delta variant has become the dominant coronavirus strain in the United States. Mario Tama/Getty Images hide caption

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Mario Tama/Getty Images

While the delta variant of the coronavirus has quickly become the dominant strain in the United States, it’s not the only variant circulating in the population.

The lambda variant, first identified in Peru, is also making headlines as it has started to be identified in several states. Houston Methodist Hospital reported its first case of the variant this week. Scientists at the Medical University of South Carolina recently announced they had found the variant in a virus sample taken in April.

According to a database for scientists tracking coronavirus variants, fewer than 700 cases of the lambda variant have been sequenced in the U.S. so far out of more than 34 million coronavirus cases reported to date. But the U.S. has sequenced only a tiny fraction of its cases, so that number does not reflect the actual number of lambda cases in the country.

Fewer than 1% of U.S. cases in the last four weeks have been identified as the lambda variant, according to GISAID, a repository for genome data.

So do we need to add lambda to our list of big worries in the U.S.? Not yet, according to public health officials and experts.

The delta variant, which is more than two times as transmissible as the original strain of the coronavirus, now accounts for 83% of new coronavirus cases in the United States. Delta continues to be the central concern for public health officials.

What we know about the lambda variant

The lambda variant was first identified in Peru in August 2020, according to the World Health Organization. Cases with the variant have now been identified in 28 countries, according to GISAID — though many of those have identified only a handful of lambda cases.

Dr. Stuart Ray is a professor of medicine at the Johns Hopkins Hospital, where he specializes in infectious diseases. Ray opened one of the first COVID-19 wards at Johns Hopkins in March 2020, and he has also overseen Johns Hopkins’ COVID-19 sequencing efforts.

He tells NPR that lambda is “sort of a cousin of the alpha variant” — one of the earliest identified variants of concern.

Lambda spread until it became a dominant sequence in people with COVID-19 in Peru. The WHO noted last month an elevated presence of lambda in other South American countries, including Argentina, Chile and Ecuador. And now we know it’s present in the United States.

The lambda variant carries a number of mutations with suspected implications, such as potential increased transmissibility or possible increased resistance to neutralizing antibodies, the WHO says. But it says the full extent of those mutations’ impact isn’t yet well understood and will need further study.

While there hasn’t been clear head-to-head data, the evidence so far does not suggest the lambda variant has any great advantage over the delta variant, Ray says.

“Delta is clearly dominating right now. And so I think our focus can remain on delta as a hallmark of a highly infectious variant. And there’s some evidence that it might cause greater severity per infection, although that’s still a developing story,” he says.

A doctor checks a lung X-ray while visiting a patient with COVID-19 in Comas, in the northern outskirts of Lima, Peru. Ernesto Benavides/AFP via Getty Images hide caption

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Ernesto Benavides/AFP via Getty Images

The COVID-19 vaccines work well against variants

There isn’t yet full data on vaccine effectiveness against the lambda variant. But so far, studies have found that the vaccines available in the U.S. provide protection against the major strains of the virus, including the highly transmissible delta variant.

“We know that vaccination almost uniformly protects people,” Ray says.

The vast majority of hospitalizations and deaths from COVID-19 in the U.S. now are among unvaccinated people.

Studies have found that the vaccines are less effective at generating neutralizing antibodies against the variants of concern than against the original strain of the virus. But T cells also play a significant role in the body’s immune response, and T cell response isn’t measured in neutralizing-antibody clinical tests — meaning that the vaccines could be more effective against the variants than is suggested by tests of antibody response alone.

WHO says lambda is a variant of interest. CDC does not

The WHO now assigns Greek letters to strains of the coronavirus that are classified as variants of concern or variants of interest. A variant of concern is one that has characteristics such as being significantly more transmissible or more virulent.

The alphabetical order of the variants’ Greek-letter names indicates the order in which they were identified as potentially important — they are not in any particular alphabetical order of severity.

The alpha, beta, gamma and delta variants are all considered variants of concern by the WHO.

The WHO classified lambda last month as a global “variant of interest” — a step below variant of concern. That means it exhibits genetic changes suspected of affecting its transmissibility and disease severity and has been identified as causing significant community transmission or multiple COVID-19 clusters.

The Centers for Disease Control and Prevention keeps its own list of variants of concern and interest within the United States. Notably, lambda is not on the CDC’s list as being a variant of interest, concern or high consequence.

Ray says tracking variants is important so that we don’t get blindsided by one’s sudden arrival.

“We have to be vigilant for these new variants and track them. Genomic epidemiology remains an important activity for us to understand this epidemic,” Ray says. “But I think right now lambda is a variant of interest, and we’ll see whether it becomes a variant of concern.”

The things we need to do to counter new strains are the same things that we already know to do to counter the coronavirus — and the stakes are high because delta is so transmissible.

That means vaccination is more important than ever, Ray says: “As the variants become more infectious, then the proportion of vaccinated people required to control the epidemic increases.”

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China Has Rejected A WHO Plan For Further Investigation Into The Origins Of COVID-19



In this May 24, 2021 file photo, Tedros Adhanom Ghebreyesus, Director General of the WHO, speaks at WHO headquarters, in Geneva, Switzerland. The WHO is asking China to be more transparent as scientists search for the origins of the coronavirus. Laurent Gillieron/AP hide caption

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Laurent Gillieron/AP

BEIJING — China cannot accept the World Health Organization’s plan for the second phase of a study into the origins of COVID-19, a senior Chinese health official said Thursday.

Zeng Yixin, the vice minister of the National Health Commission, said he was “rather taken aback” that the plan includes further investigation of the theory that the virus might have leaked from a Chinese lab.

He dismissed the lab leak idea as a rumor that runs counter to common sense and science.

“It is impossible for us to accept such an origin-tracing plan,” he said at a news conference called to address the COVID-19 origins issue.

The search for where the virus came from has become a diplomatic issue that has fueled China’s deteriorating relations with the U.S. and many American allies. The U.S. and others say that China has not been transparent about what happened in the early days of the pandemic. China accuses critics of seeking to blame it for the pandemic and politicizing an issue that should be left to scientists.

Tedros Adhanom Ghebreyesus, the director-general of WHO, acknowledged last week that there had been a “premature push” after the first phase of the study to rule out the theory that the virus might have escaped from a Chinese government lab in Wuhan, the city where the disease was first detected in late 2019.

Most experts don’t think a lab leak is the likely cause. The question is whether the possibility is so remote that it should be dropped, or whether it merits further study.

The first phase was conducted earlier this year by an international team of scientists who came to Wuhan to work with their Chinese counterparts. The team was accused of bowing to demands from the Chinese side after it initially indicated that further study wasn’t necessary.

Zeng said the Wuhan lab has no virus that can directly infect humans and noted that the WHO team concluded that a lab leak was highly unlikely. He added that speculation that staff and graduate students at the lab had been infected and might have started the spread of the virus in the city was untrue.

Yuan Zhiming, the director of the biosafety lab at the Wuhan Institute of Virology, said they had not stored or studied the new coronavirus before the outbreak. “I want to emphasize that …. the Wuhan Institute of Virology has never designed, made or leaked the novel coronavirus,” he said.

The WHO team concluded that the virus most likely jumped from animals to humans, probably from bats to an intermediate animal. The experts visited markets in Wuhan that had sold live animals, and recommended further study of the farms that supplied the market.

“In the next step, I think animal tracing should still be the priority direction. It is the most valuable field for our efforts,” Liang Wannian, who headed the Chinese side, said at Thursday’s news conference.

Tedros said last week that he hoped for better cooperation and access to data from China. “We are asking China to be transparent, open and cooperate, especially on the information, raw data that we asked for in the early days of the pandemic,” he said.

His words were echoed at the same virtual news conference by Germany’s health minister, Jens Spahn, who called on China to intensify cooperation in the search for the origin of the virus.

Zeng said China has always supported “scientific virus tracing” and wants to see the study extended to other countries and regions. “However, we are opposed to politicizing the tracing work,” he said.

China has frequently sought to deflect accusations that the pandemic originated in Wuhan and was allowed to spread by early bureaucratic missteps and an attempted coverup.

Government spokespersons have called for an investigation into whether the virus might have been produced in a U.S. military laboratory, a theory not widely shared in the scientific community.

China has largely ended local transmission of COVID through lockdowns and mask-wearing requirements, and has now administered more than 1.4 billion doses of Chinese vaccines. Just 12 new domestically spread cases were reported Thursday and China’s death toll from the virus has remained unchanged for months at 4,636.

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