We’re two frontline COVID doctors. Here’s what we see as case numbers rise

Peter Wark, University of Newcastle and Lucy Morgan, University of SydneyThe latest figures available show there are 1,189 people admitted with COVID-19 to hospitals in New South Wales, with 222 of them in intensive care units (ICU), 94 needing ventilation.

This week there were over 9,700 people with new COVID infections. That means about one in every 10 people with COVID are sick enough to need admission to hospital.

Recently released modelling predicts COVID admissions in NSW will rise steeply over the coming weeks and will peak in mid-October. NSW has also just announced plans for some restrictions to ease once 70% of adults in the state are fully vaccinated, a date also expected to land in October.

Here’s what this will look like for patients admitted with COVID and for hospital staff caring for them.

Here’s what happens to the lungs

Healthy lungs are like soft, fresh sponge cake, wrapped in two layers of cling wrap (the pleura), all sealed in the cake tin of the chest wall.

But with severe COVID, people develop pneumonia. This is when the spongey lung fills with fluid and becomes stiff and the muscles we use to breathe are weakened by inflammation that rages in all tissues of the body. The major consequence of this is an inability to breathe properly, a reduction in oxygen levels and inadequate oxygen supply to the body.

Severe pneumonia is usually managed in the ICU. In this pandemic, the sheer number of critically breathless patients means the intensive level of respiratory care they require is being delivered outside ICU, in wards designed for patients with other health problems.

So most of the patients admitted to hospital with COVID are actually managed by lung specialists and infectious diseases physicians with a huge input from our junior doctors in training.

COVID pneumonia is what kills patients who develop severe COVID.

About one in five develop severe breathlessness. This is when the stiffened lungs are full of fluid and every breath requires extra effort.

This severe breathlessness is hard to explain until you experience it. But it’s relentless, exhausting and frightening. Patients describe it as like “an elephant on your chest”, “a suffocation”, or there not being “enough air in the room”.

Read more:
ICU ventilators: what they are, how they work and why it’s hard to make more

People with COVID pneumonia need oxygen but oxygen alone isn’t enough to help with severe breathing difficulties and COVID pneumonia. Those who are most unwell may need intubation. This is when we insert a tube into the lungs connected to a machine that does the work of breathing, via mechanical ventilation. This happens in the ICU.

Expert care in an acute COVID ward is critical. Patients successfully managed will have better odds of a shorter hospital stay and not needing intubation, with its increased risk of dying.

We’re also worried about filling up the available ICU beds — a clearly finite resource.

Read more:
We’re seeing more COVID patients in ICU as case numbers rise. That affects the whole hospital

We want to avoid intubation

As the pandemic has swept across the globe, we’ve rapidly learnt from our colleagues overseas about supporting the breathing of patients with COVID pneumonia.

Our treatments are aimed at helping patients recover more quickly and reduce the need for mechanical ventilation. Measures include:

  • delivering warm and humid oxygen, which is more comfortable for patients, and protects the lining of the airways from further inflammation
  • lying patients on their belly or “proning”, aims to prevent fluid from pooling at the bottom of the lungs. This improves oxygen levels and makes breathing more comfortable. It also reduces the need for mechanical ventilation. This is safe and cheap, and is comfortable for most people even those who are very overweight, and pregnant women
  • continuous positive airway pressure or CPAP can also be used to help reduce the work of breathing for people with severe breathlessness. These machines are used to deliver oxygen via a mask and help by opening up fluid-filled, stiff lungs.

These treatments are labour intensive and have long been available in the ICU where nursing to patient ratios are higher.

However, in NSW, hospitals with the highest current numbers of patients with severe COVID (such as Liverpool, Nepean and Westmead) have had to rapidly adapt their wards to deliver this treatment outside the ICU.

The published modelling predicts such treatments will spill further into the COVID wards of every hospital in NSW.

Read more:
Opening with 70% of adults vaccinated, the Doherty report predicts 1.5K deaths in 6 months. We need a revised plan

We need the staff to manage this

Treatments like proning and CPAP are time-consuming and require experienced doctors, nurses and support staff.

Ideally, every patient with severe COVID pneumonia should have at least one nurse each for every hour of the day — a 1:1 nursing ratio.

Staff need to know when to start these treatments. They also need to know how to read the signs of deterioration that signal the patient, who despite everyone’s best efforts, will need intubation.

Fitting the CPAP mask and adjusting the oxygen requires experience and training. Staff help patients to eat and drink, go to the toilet. They administer complex medications, comfort the grieving, frightened and confused.

They do this while dressed in a hot gown, wearing goggles and gloves and a tight, fitted N95 mask. Every single clinical interaction is stressful and intense.

Read more:
‘Living with COVID’ looks very different for front-line health workers, who are already exhausted

Plans are under way

Plans are under way to manage the expected surge in cases.

Staff are being trained and we are preparing to get enough equipment where it’s needed. The problem is this will go on for many more weeks, staff will get tired, physically and emotionally, and we don’t want this to be any worse than it must be.

If you want to help, get vaccinated and stay at home. Please put up with the restrictions and lockdowns for a little longer.

Now is the time for everyone to come together so we come out of this in one piece and can continue to offer the best of medical care.The Conversation

Peter Wark, Conjoint Professor, School of Medicine and Public Health, University of Newcastle and Lucy Morgan, Clinical Associate Professor, Concord and Nepean clinical schools, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hostilities Flare in BJP-Run Madhya Pradesh, India

Anti-Christian violence, efforts to tarnish church increase in past five years.

NEW DELHI, October 14 (CDN) — Since the Hindu nationalist Bharatiya Janata Party (BJP) came to power in Madhya Pradesh in December 2003, Christians in the state have suffered increased attacks and concerted efforts to tarnish their image, church leaders said.

Before the BJP took office the state recorded two or three attacks against Christians per year, they said, whereas Jabalpur Archbishop Gerald Almeida said that in the past five years 65 baseless charges of forceful conversion – commonly accompanied by mob violence – have been registered in his diocese alone.

“There are some groups who are closely monitoring the Christian movement, and these people are bent on creating problems for the Christians for the past five years,” Almeida told Compass.

The state is not able to control these groups, he added. Indeed, police routinely working with Hindu extremist groups filed an average of more than three unsubstantiated complaints of “coerced” conversions each month in the past five years, according to the Catholic Bishops’ Conference of Madhya Pradesh (see sidebar below).

In the first eight months of this year, Madhya Pradesh saw the third highest number of attacks against Christians and Christian institutions in the country with 11, behind Karnataka with 43 and Andhra Pradesh with 14, according to Christian advocacy organizations.

The Rev. Anand Muttungal, spokesman for the Catholic Bishops’ Conference of Madhya Pradesh, said growing attacks on Christians were a symptom of fear among Hindu extremists that the Catholic Church’s influence is spreading.

“The Church as an organization is doing very well in many fields,” Muttungal said. “It causes those fundamentalists to worry. It could be one of the main reasons for the continuous attacks on Christians.”

Madhya Pradesh has a Christian population of 170,381, only 0.3 percent of the total in the state, according to the 2001 census. The state’s history of religious intolerance runs deep, with an “anti-conversion” law passed in 1968 that has serves as a pretext for harassing Christians.

Igniting anti-Christian violence shortly after the BJP came to power was an incident in Jhabua district, where the body of a 9-year-old girl called Sujata was found in one of the Christian schools on Jan. 11, 2004. Although a non-Christian confessed to the crime, Hindu extremists used the event to justify various attacks against the Christian community.

Abuses became so rampant in 2005 and 2006 that the National Commission for Minorities (NCM) sent a fact-finding team to Madhya Pradesh and Chhattisgarh in June 2006. Investigators found that Hindu extremists had frequently invoked the state’s anti-conversion law as a means to incite mobs against Christians and to get Christians arrested without evidence.

Jabalpur Archbishop Almeida cited cases chronicled by the NCM such as the arrest under the anti-conversion law of two local women who were merely distributing gospel tracts in March 2006. Almeida also cited the NCM report on the jailing of four pastors in January 2006 for alleged “forceful conversion” after Hindu extremists from the Bajrang Dal dragged them to a Hindu temple and forced them to deny Christ.

Catholic Church records show that in 2007, a 70-year-old woman identified only as Mrs. Godwin was arrested along with another woman on charges of forceful conversion; they too were only distributing religious literature, a right they had under the nation’s constitution.

Christian leaders said one aim of such abuses of the state’s anti-conversion law is to tarnish the image of Christians by showing them as lawbreakers. Hate propaganda and spurious allegations against Christians continue unabated in the state, church leaders said.

The customary practice in India and especially in Madhya Pradesh, they said, is for Hindu extremists to raise false allegations on the slimmest of pretexts and get police to make hurried arrests.

Political Machinery

After the NCM report in 2006 first documented the violence, the Madhya Pradesh political machinery’s influence became evident when State Minorities Commission Chairman Anwar Mohammed Khan asserted that reports of Hindu extremists attacking Christians in the state were “baseless.”

Khan told Frontline magazine that extremists had not targeted Christians. The magazine also quoted state Chief Minister Shivraj Singh Chauhan as saying the BJP government was greatly concerned about “unethical conversions” – presumably of Hindus to Christianity.

The magazine criticized the state Minorities Commission for speaking “the same language as the Bajrang Dal and the state chief minister,” thereby failing its mandate to defend minorities.

This year the commission tried to increase state control over church activities, unofficially recommending that the government enact a law to set up a board to manage church properties such as schools, colleges, hospitals and charities. The Christian community strongly protested, and the state withdrew the proposal.

Leo Cornelio, archbishop of Bhopal, said the Minorities Commission recommendation “shows beyond doubt that it is disloyal to minorities” and “loyal to the government,” according to the Indian Catholic.

The battle over state control of church properties is not over. Muttungal told Compass that the Minorities Commission has started to collect details of church properties through the Education Department. It is certain, he said, that this will lead to a legal battle involving the Education Department, Minorities Commission and the Catholic Church.


Police Collusion Seen in ‘Forced Conversion’ Complaints

NEW DELHI, October 14 (Compass Direct News) – Hindu extremist groups in collusion with the state police filed an average of more than three baseless complaints of “coerced” conversions per month in the past five years – shortly after the Bharatiya Janata Party (BJP) came to power – according to the Catholic Bishops’ Conference of Madhya Pradesh.

“I have gathered information from all the districts of the state, according to which the number of [forced or fraudulent] conversion complaints against Christians in the last five years is over 180,” the Rev. Anand Muttungal, spokesman for the state’s Catholic body, told Compass.

Muttungal said he asked the Madhya Pradesh State Crime Records Bureau, a body under the state interior ministry that monitors criminal complaints, about the number of forced conversion complaints in the last five years, and the state agency put the number wrongly at fewer than 35.

Muttungal also said most of the complaints were filed by third parties – not the supposed “victims” – who were unable to produce any unlawfully converted people to support their allegations. He added that the complainants were mainly members of the Hindu extremist Bajrang Dal, youth wing of the Vishwa Hindu Parishad (World Hindu Council or VHP).

“In Jabalpur, the complaints were lodged mainly by the Hindu Dharam Sena [Hindu Religion Army],” he said.

Most recently, the leader of the Hindu Dharam Sena on Sept. 27 got police to interrogate, without cause, a Catholic group traveling through Jabalpur. The Rev. Anto Mundamany of the Carmelite of Mary Immaculate order said the inspector-in-charge of the Civil Lines police station and four other policemen came to the Carmel Niketan center, where the group had stopped for dinner. Police interrogated him and the 45 Catholic visitors about their religious identity, he said, to determine whether the visitors were Hindus whom the priests and nuns at the center might be forcibly trying to convert.

Journalists accompanied the police, and the following day local newspapers reported on the incident, portraying the Christians as inherently suspect.

“Although the police left after making sure that all the participants who had arrived for an inter-parish tour were Christians, the newspapers made no mention of that fact,” Mundamany said.

The local daily Dainik Bhaskar reported that Yogesh Agarwal, head of the Hindu Dharam Sena, had informed police about a supposed “conversion plot” by the Catholic order.

“There can be little doubt that the police are party to this disturbing trend,” Muttungal said.

The incidence of anti-Christian attacks is the highest in the state in Jabalpur – local Christians say the city witnessed at least three attacks every month until recently, mainly by Agarwal and his cohorts. Although numerous criminal complaints are pending against Agarwal, he remains at large.

A Christian requesting anonymity said police officers personally act on his complaints against Christian workers.

A June 2006 report by the National Commission for Minorities (NCM) found that Hindu nationalist groups in Madhya Pradesh had frequently invoked the state’s anti-conversion law as a pretext to incite mobs against Christians. The NCM report also pointed at police collusion in the attacks.

“The life of Christians has become miserable at the hands of miscreants in connivance with the police,” the NCM said in its report. “There are allegations that when atrocities were committed on Christians, the police remained mere spectators, and in certain cases they did not even register their complaints.”

The NCM is an independent body created by Parliament in 1993 to monitor and safeguard the rights of minorities.

Muttungal said the Catholic Bishops’ Conference would approach the state high court with the facts it has gathered to prove police involvement in complaints against Christians.

Most complaints against Christians are registered under Section 3 of the Madhya Pradesh “Freedom of Religion Act” of 1968, popularly known as an anti-conversion law. The section states, “No person shall convert or attempt to convert, either directly or otherwise, any person from one religious faith to another by the use of force or by inducement or by any fraudulent means nor shall any person abet any such conversion.”

Offenses under the anti-conversion law are “cognizable,” meaning police are empowered to register a complaint, investigate and arrest for up to 24 hours, without a warrant, anyone accused of forced conversion.

Police also use Sections 153A and 295A of the Indian Penal Code (IPC) to arrest Christians. Section 153A refers to “promoting enmity between different groups on grounds of religion and doing acts prejudicial to maintenance of harmony.” Section 295A concerns “deliberate and malicious acts to outrage religious feelings.” These IPC crimes are also cognizable.

Report from Compass Direct News 

IRAN: Video from the Frontline

With the crisis in Iran continuing following disputed elections, I thought it would be useful to post some video footage of what is taking place in Tehran and elsewhere in the country. With protests continuing, hopefully regime change may be a reality and the people of that country finally enjoy freedom.