COVID Confusions

COVID-19 is a new acronym coined for Corona-Virus-Induced-Disease of the year 2019. Year 2020 made some old word or phrases suddenly very fashionable and buzzing with new meanings, and injected them into active vocabulary of people. Corona, a word hitherto associated with the Sun, novelty and SARS-Coronavirus-1 was not so much in use but became suddenly a dreaded word linked to COVID-19. Positivity, a word that was generally used for the practice of being or tendency to be positive or optimistic in attitude up until then, took on the other meaning of the presence rather than absence of a certain substance, condition, or feature, now a measure of incidence of disease.

Check out some of these words or phrases for yourself, because your inability to use them in conversations may be mistaken as your ignorance – animal-human interface, asymptomatic, carrier, clinical trials, community spread, contact tracing, Contagious, Droplets, Epidemic, flatten the curve, herd immunity, HRCT scan, incubation period, Isolation, Mask, mRNA Vaccines, Mutant, Outbreak, Oxygen-concentrator, Oximeter, Pandemic, Pathogen, patient zero, PCR test, personal protective equipment (PPE), Plasma, Quarantine, Rapid-Antigen Test, Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), Screening, self-isolate, social distancing, Super spreader, Symptomatic, Transmission, Vax, Ventilator, Viral Vector Vaccines, Zoonotic – and the list goes on.

Some proper nouns also made their way in the active vocabulary – Wuhan, AstraZeneca, Covax, Covaxin, Covishield, Sputnik5, Pfizer-BioNTech, Moderna, Johnson & Johnson’s Janssen, Novavax, Coronil, CoviSelf, Remdesivir, 2-DG, and so on; but the most conspicuous proper noun is FAUCI.

Anthony Stephen FAUCI (born December 24, 1940) is an American physician-scientist and immunologist who serves as the director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and the chief medical advisor to the president. He has acted as an advisor to every U.S. president since Ronald Reagan. From 1983 to 2002, Fauci was one of the world’s most frequently cited scientists across all scientific journals. In the early stages of the COVID-19 pandemic, The New Yorker and The New York Times described Fauci as one of the most trusted medical figures in the United States. Currently Fauci is the Chief Medical Advisor to President Joe Biden, officially appointed in 2021.

After initially declaring in April of last year that the virus was “not a major threat to the people of the United States” and that it was “not something the citizens of the United States right now should be worried about,” Fauci repeatedly urged Americans not to wear masks early in the pandemic. Later, Fauci admitted that he had believed all along that masks were effective but said he had wanted to ensure that supplies would be reserved for medical professionals. In other words, he asserted that he had the right to lie to the public for what he believed to be their own benefit. If Fauci is correct that masks effectively contain the spread, then the cost of his misinformation as the pandemic worsened may be incalculably large, for the US community. (https://www.delcotimes.com/opinion/chris-freind-dr-fauci-needs-a-dose-of-reality/article_9bce984e-7641-11eb-8c87-4f0114a8a7a2.html )

After repeatedly dismissing the theory that the COVID-19 virus escaped from the Wuhan Institute of Virology in China, Fauci now says he cannot rule out the theory.

Fauci has now backtracked on his comments about the National Institutes of Health (NIH) funding for the Chinese lab under his leadership, that funding was not for “gain of function” research, a laboratory technique that intentionally makes pathogens more dangerous and transmissible. Gain of function research in Wuhan was indeed funded through one of Fauci’s grants.

Late last week, COVID policies stated that fully vaccinated individuals do not need to wear masks indoors or outdoors, any longer. Defending the policy, Fauci declared that the abolition of mask mandates was not a contradiction of previous policy but instead followed “evolving science” on the virus; although no examples of this supposedly new scientific evidence were forthcoming. Fauci then added to the confusion by declaring, apparently on his own authority, that young children would still be required to wear masks in school. Then, just a gay later, Fauci suggested that it was “reasonable” for businesses to maintain mask mandates even for vaccinated Americans, in blatant defiance of the CDC’s recent guidance. Whichever way one looks at it, Fauci has become a key player in the current controversy, which completes his transformation from an independent doctor into a political football, at the age of 80 years.

Fauci has also steadily moved the goalposts on the percentage of the population that will need to be vaccinated to achieve herd immunity. Earlier this year, he said herd immunity would be achieved when 60% were vaccinated; in recent interviews, he has spewed out numbers as high as 85%. At the very least, the top infectious diseases expert of the US and chief medical adviser to Biden is loose with the facts and is prone to changing his mind. To be fair, the pandemic caught a lot of people unaware, but the thing about Fauci is that he always is so sure of himself. (https://nypost.com/2021/01/24/dr-fauci-needs-to-be-held-responsible-for-mistakes-devine/ ).

India has done well in vaccinating the armed forces personnel with 90% of them having already received both doses of vaccine. India did not listen to the US guidelines (CDC) on reopening of schools, which is now being associated with untold misery that followed in Texas.

Luckily, Indian policy-makers do listen to Dr. Anthony Fauci but do not blindly subscribe to all his utterances. Good, is not it, that while being open to all the information, suggestions, knowledge and advice coming from everywhere, we have a mind of our own. When it comes to inconsistent and improvisational COVID messaging, no one can surpass Dr. Anthony Fauci.

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First published 24 May 21

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Management Education Requires Radical Reconstruction

Having successfully impressed upon the entire business community the need for ‘vision statements’ and ‘defining their purpose and mission’, it is the business schools themselves who have failed to internalise these ideas and their own management leaves much to be desired.

If one were to use a simple input-process-output model to examine what they do, business schools are unsure about what the input (incoming students) they seek is, what the process they subject this input to is, and what is the output they churn out.

Business schools are unable to articulate, say and implement if they educate, train or facilitate learning among – future managers who would also have leadership and entrepreneurial capabilities; or future leaders who would also have managerial and entrepreneurial capabilities; or future entrepreneurs who would also have leadership and management capabilities; or something else. 

Business schools fail to comprehend that their process for teaching and learning is completely different from the processes adopted in other streams of knowledge. Most other streams of education use methods of description and recreation of phenomenon through attempting to describe the how/why of occurrences and then letting the learner recreate the occurrence in the laboratory – thereby generating one’s own data to see if one can arrive at the same descriptions of occurrences leading to acceptable and replicable generalisations about the how/why of such phenomenon. In contrast, business-schools enable learning through ‘mimicry’ of some singular phenomenon. Learners receive descriptions of some episodes with some speculation about how/why of that occurrence. A learner is unable to generate own data to arrive at similar how/why of such phenomenon. No acceptable or replicable generalisations about the how/why of similarly repeating episodes is possible.

Unsure of what output they intend to produce using methods of mimicking, business schools are even unsure of the kind of student they wish to recruit. Business schools are unable to define the prior-learning (both through formal education and through experience) with which their students would come on board for a graduate degree in Business.

Simple Description of Graduate Management Education In India

Many economic and competitive forces have directly impacted management education institutions during the last two decades or so over which, business schools had little control. Most institutions were far too risk-averse to adequately respond. There should be no doubt that the economic and competitive market in which we all operate has been permanently altered by Covid-19. 

The demands of today’s marketplace call for a new set of skills and abilities. In this sense then, business schools must align themselves with an evolving context for leadership, which should be embedded in the curricular and co-curricular experiences of business students. These new models of leadership would be defined by instability, non-repeating and unlikelihood of events.

While ‘change is a constant’ and ‘all management is change-management’ are the clichés, the realisation that in spite of nearly everything changing continuously or discontinuously, human beings are not changing, and hence human needs are not changing, has to sink-in. The needs for survival, safety, affiliation, self-realisation (esteem, cognitive, aesthetic), self-actualization (achievement, accomplishment) and self-transcendence (visionary intuition, altruism, unity consciousness) are the same as they were in the last century. How people connect as informal organisations or formal organisations changes, but why they connect is not changed.  Greed and selfishness for power and wealth has not changed, nor has altruism vanished. Right was never the might in human history and there is no change in this facet of civilisation. Might is right as it always was. What constitutes might may change. Means are constantly changing not the ends.

Business schools need to create reciprocal, mutually beneficial collaborations with all kinds of business and non-business organisations in order to prepare today’s students for an economic marketplace that, in many instances, doesn’t yet exist. This reflects an uneasy, but an essential sea-change.  Curricula and related activities have historically been the sole domain of the faculty and an extension of the academic enterprise but business schools have to recognise that the curricula and related activities required for succeeding tomorrow is neither their monopoly nor does it probably exist with them.

Business schools have to equally appreciate that access and delivery methods – blended, synchronous, asynchronous, full-time, part-time, virtual or physical are all methods of delivery of knowledge and education. Learning is independent of these methods. Learning has always been blended and facilitated or mediated by multiple actors including peers. Business schools can only design and control the delivery systems but learning is a personal and internal process for an individual learner. Yet, business schools have to bear the responsibility of learning over which they have little control besides being enablers and facilitators. The need for business schools to adapt their approaches, as well as their requisite business and revenue models, to evolving learners’ convenience is imperative.

Near commoditization of the management education industry makes it difficult for all but the most sophisticated consumer to discern the difference between many of the programs offered and the new platforms for delivery. Undifferentiated products and undifferentiated marketing is recipe for failure. The opportunity lies in designing differentiated products for different learners segmented on the basis of differences in their prior learning. Allowing customer-self-selection would provide the benefit of customer preference rather than institutional prescription.

Business schools have to define the input-process-output of their enterprise and these three are the themes for defining the management education sector.

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First Published 29 June 2021

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See Behind the Curtain of QS World University Rankings 2022

I will begin on a lighter note because what follows is serious and may be tough, harsh and unsavoury for quite a few learned people.

There is a joke about a man asking his son about his result in the school, which is narrated nearly in all parts of the country. Rendered in local dilect with local nuances and cultural flavour, the outcome is always hilarious.  This joke goes something like this –

Man (to his son Ramu) – tell me, whether you passed this time or have failed the exams once again

Ramu (replying to his father) – I have stood fourth in the class

Man – very good Ramu, but did you pass

Ramu – Gopal (Head master’s son) has stood sixth in the class, I have done better than Gopal

Man – Poor Gopal, he remained behind you, but did he pass or not

Ramu – only Dheeru and Golu passed, they stood first and second. Don’t get angry with me, I am better than 36 in my class. Only 3 are better than me.

Man (in angry and abusive tone) – Idiot, you failed again

Clearly, the result was only 5% (2 out of 40) pass rate.

Let us now look at the QS World University Rankings 2022. India has celebrated that three of our institutions – IIT Bombay (shared rank 177), IIT Delhi (rank 185) and IISc Bangalore (shared rank 186) continue to remain in the top 200 ranked Universities of the World even in 2022. The Prime Minister (https://twitter.com/narendramodi/status/1402628065474203650) and the Education Minister (https://twitter.com/DrRPNishank/status/1402559433259962371) also congratulated these institutions, and rightly so, rankings do give us a sense of achievement. We need to be careful however, if our euphoria (https://timesofindia.indiatimes.com/india/india-emerging-a-vishvaguru-says-ramesh-pokhriyal-after-3-indian-institutes-figure-in-top-200-qs-world-university-rankings/articleshow/83373333.cms ) is like that of a Ramu or a Golu?

QS World University Rankings 2022 feature 1,300 universities from around the world. There are 35 Indian Universities in this list of 1300. (https://www.topuniversities.com/university-rankings/world-university-rankings/2022 )

Universities were evaluated according to a weighted average of the six metrics – Academic Reputation (40%), Employer Reputation (10%), Faculty/Student Ratio (20%), Citations per faculty (20%), International Faculty Ratio (5%), and International Student Ratio (5%).

The matrices are reported as measurements on an analogue interval scale (0-100) which are then aggregated into an overall score (weighted average). The overall score is therefore on an analogue interval scale (0-100).

The overall score was then ordered from high to low and discreet ranks awarded as 1, 2, 3, and 4 and so on. Universities tied at same overall score share the same rank and the next rank is then skipped to account for double cases at same rank. In such ranking, among the top 200 ranks, three institutions from India figured.

Let us try to see beneath the veil of these ranks.

  • MIT, which ranks first has an overall score of 100 (rounded up) composed of Academic Reputation (40% of 100), Employer Reputation (10% of 100), Faculty/Student Ratio (20% of 100), Citations per faculty (20% of 100), International Faculty Ratio (5% of 100), and International Student Ratio (5% of 91.4).
  • The overall scores are thus some kind of ratings for the Universities. Interestingly, as we go down the ranking list, the overall score drops very fast – Carnegie Mellon University, Pittsburgh United States scores less than 75% but ranks at 53; Hanyang University, Seoul South Korea scores less than 50% but ranks at 156; Maastricht University, Maastricht Netherlands scores less than 50% but ranks at 156; and University of Missouri, Columbia United States scores less than 25% but ranks at 476.
  • Overall Scores for Universities ranked at 501 or lower are nor reported (they scored 24 or less out of 100)

Let us revert to performance by the institutions from India. There are 35 institutions from India in the list of 1300 ranked institutions, of which 3 are in top-200, 5 more are in the 201-500 group, another 14 are in the next 500 ranks while the remaining 13 are in the last 300 ranks. The top-3 institutions from India are rated and ranked as under:

  • IIT Bombay (Academic Reputation -51.3, Employer Reputation -79.6, Faculty/Student Ratio- 32.5, Citations per faculty -55.5, International Faculty Ratio – 1.5, International Student Ratio – 1.6; Overall score – 46.4; rank-177),
  • IIT Delhi (Academic Reputation -45.8, Employer Reputation -70.8, Faculty/Student Ratio- 30.9, Citations per faculty -70.0, International Faculty Ratio – 1.2, International Student Ratio – 1.7; Overall score – 45.9; rank 185)

and

  • IISc Bangalore (Academic Reputation -34.2, Employer Reputation -19.2, Faculty/Student Ratio- 48.8, Citations per faculty -100.0, International Faculty Ratio – 1.2, International Student Ratio – 1.8; Overall score – 45.7; rank 186)

The next 5 ranked institutions are:

  • IIT Madras (Overall score – 38.1, rank 255),
  • IIT Kanpur (Overall score – 36.4, rank 277),
  • IIT Kharagpur (Overall score – 36.3, rank 280),
  • IIT Guwahati (Overall score – 28.3, rank 395) and
  • IIT Roorkee (Overall score – 28.0, rank 400).

Here is what the rating data displays:

  • Only the public institutions of technology and science are able to find a place in the top-500 club. These are deemed to be universities but not a university in the real sense of the term. A university is multi-disciplinary, spanning across humanities, science, commerce and social sciences rather than being confined to a very narrow focus on technology.
  • There is no real Indian University in the top-500 ranks. South Africa has 4 real universities in the top-500 club.
  • As against 8 institutions from India in the top-500 club, Europe has 212 institutions, United States has 87 institutions while Rest of Asia has 117 institutions (includes 26 from mainland China, 16 from Japan).
  • These 8 institutions do not account for even 1% of the total university enrolment in India.
  • The best of best in India scores only 46% marks as compared to the best in the world score of 100%.
  • There are large variances in the scores for Academic Reputation, Employer Reputation, Faculty/Student Ratio and Citations per faculty within the top 3 whose ranks are spread over only 9 ranks.
  • Employer reputation seems to exceed Academic Reputation for the high ranked institutions in India. IISc turns out to be an exception in reputation as well as in its Citation score.

Makeup is used as a beauty aid to help build up the self-esteem and confidence of an individual. Like NIRF Rankings (https://www.researchgate.net/publication/350354434_NIRF%27s_India_Rankings_Are_Ludicrous) QS World University Rankings 2022 are a makeup for educational institutions. This makeup conceals the ugly pockmarks on the face of Universities in India. It is unfortunate that the Education Minister has utilized this makeup to beat the harsh lights and the glare of camera flashes which would expose the rot in education system.

By calling these rankings as a testimony for India’s “leap in the field of Education & Research and is emerging as a VISHVAGURU” Education Minister is only proving his lack of understanding and literateness. Surely, he remembers well – “Parde Mein Rehne Do Parda Na Uthao, Parda Jo Uth Gaya To Bhedh Khul Jayega, Allah Meri Tauba – Allah Meri Tauba” (परदे में रहने दो पर्दा न उठाओ, पर्दा जो उठ गया तो भेद खुल जायेगा, अल्लाह मेरी तौबा – अल्लाह मेरी तौबा) keep the curtain on, don’t lift the curtain, If the curtain is lifted, then the secret will be revealed, Allah is my repentance – Allah is my repentance.

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First published 12 June 2021

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Demystifying Politics in Democracy

Democracies are governance by the people, presumably for the people. They are also supposedly ‘of the people’ because to govern themselves, people elect some individuals out of themselves to represent them in government.

People elect representatives based upon their personal opinions and motivations, both of which are subjective. Voting someone to office is an emotional response of people.

While people carry on with their lives working as wagers or professionals or businesspersons, some choose to take up politics as their livelihood and put themselves up for being elected to office by the people.  Most democracies are federal structures, meaning thereby that there exist multiple tiers of governments. An individual citizen thus has a Member of Parliament, a Member of Legislative Assembly, and a member of Municipality or a Gram Panchayat to represent him at these tiers of Government. Then, people also elect representatives to self-help groups like worker-unions, student unions, charities, social groups, clubs, welfare groups, cooperative societies, religious bodies, and so on. Politicians have the choices of being elected to any of these tiers in the government as well as to these self-help groups. People get the opportunities to elect their representatives every five years or sooner.

Since the governance is itself a collective of the majority of the elected individuals, politicians are categorised into affiliate groups – chosen to govern or rejected to govern – for the time being. Depending upon the pro-incumbency voting or anti-incumbency voting by people, in the next round of elections, the politicians are able to keep or reverse the nature of their affiliate category.

Accordingly, the predominant policy of the politician from the group ‘chosen to govern’ is to garner pro-incumbent public opinion and inoculate the minds of people to protect them from any counter attacks of the politician from the group ‘rejected to govern.’ They trumpet their achievements and promises through events and seek amplification of their narrative through the media and press.

The predominant policy of the politician from the group ‘rejected to govern’ is to garner enough anti-incumbent public opinion before the next election, which would result into the incumbents being voted out and the group ‘rejected to govern’ would emerge as the group ‘chosen to govern’ after those elections.

Building up of anti-incumbent public opinion is achieved through developing a passive resistance to the policies of the group ‘chosen to govern’ and this requires continuing demonstration of active-resistance by the politicians from the group ‘rejected to govern’ to the policies and actions of the incumbents. Strikes, shutdowns, slowdowns, sit-ins, sloganeering are some of the tools used in such demonstrations. Resulting events create content for the media and the group ‘rejected to govern’ seeks amplification of their events and their narrative through the media.

Both the groups, group ‘rejected to govern’ and group ‘chosen to govern’ also indulge in comparative narrative involving disparaging each other and seek the help of media in their efforts. 

The fact is that the role, purpose and importance of newspapers and news broadcasts, as reporters and chroniclers of facts, which could count as proof, has diminished. Editorials and the opinions of experts in any media, print or television, which are objective, fail to catch the attention of people.

For their entertainment value, acrimonious debates between the biased and ignorant politicians and purposive shows catch the eyeballs, but the theatrical capabilities of the performers in such shows leave false impressions in the minds of the audience. The slant of the anchors towards a particular narrative works as subliminal messaging in shaping the impressions.

Media is becoming a peddler of the narrative of the politician belonging to either the group ‘rejected to govern’ or the group ‘chosen to govern.’ Social media noise and claims do not count as proof yet they strike the emotions of people and shape public opinion.

Width, depth and sustainability of favourable public opinion is the measure of success in politics. Maximising the width, depth and sustainability of favourable public opinion is therefore the real goal of any politician. Narratives, public discourse, public policy, bureaucracy, media, political workers, safety, security, justice, growth, welfare, progress, nationalism, equality, secularism, affirmative action, patriotism, peace and rule of law are just the means in achieving of these political goals.

One can fault a politician for any of the means that they use, but none can fault them for their unwavering commitment to their goals.

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First published 04 May 2021

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Are You Joking Dr. Lele?

Evidence-Based Medicine is a hot topic ever since the unpleasant and acrimonious spat between Swami Ramdev, also known as Baba Ramdev, of Patanjali and Dr. Jayesh Lele, MBBS, general secretary of the country’s largest lobby of allopathic doctors, the Indian Medical Association, or IMA was aired on 25 May 2021.

Lele seem to claim that COVID-19 treatment being undertaken in India by the allopathic doctors is Evidence-Based Medicine, which Ramdev was unwilling to accept due to very frequent and recurring changes in the allopathic treatment-protocols being practised, the preceding ones being abandoned citing lack of evidence while the succeeding ones being merely new conjectures.  Following the dictum that ‘absence of evidence’ is not the ‘evidence of presence’ let us dispassionately and objectively examine Lele’s claim.

The updated (revised and improved) definition of Evidence-Based Medicine is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values. (David L. Sackett, Sharon E. Straus, W. Scott Richardson, William Rosenberg, and R. Brian Haynes. Evidence-Based Medicine: How To Practice And Teach EBM. 2nd edition, London: Churchill-Livingstone, 2000)

Speaking at the MLA 2010 Annual Conference, held in Washington DC, Mark Ebell, MD, MS, Associate Professor at the University of Georgia, and Editor-in-Chief, Essential Evidence Plus  defined Evidence-Based Practice as, “Making a conscientious effort to base clinical decisions on research that is most likely to be free from bias, and using interventions most likely to improve how long or well patients live.” (https://youtu.be/XWi7vNv2nos)

Evidence-based medicine includes three key components (see Figure): research-based evidence, clinical expertise (i.e., the clinician’s accumulated experience, knowledge, and clinical skills), and the patient’s values and preferences.

Practicing evidence-based medicine is advocated on the promise of improved quality, improved patient satisfaction, and reduced costs.

The EBM Pyramid (see figure) explains the knowledge types and the reliability of such evidence. Evidence in Level I is considered the gold standard of medical knowledge. Evidence in Level II comes from Controlled trials without randomization or Cohort or case-control analytic studies or multiple time series studies. It is often true that the best evidence available to clinicians is their own observed aggregate data. Evidence in Level III is based on expert opinion from experts who have narrowed their focus as much as possible about a complex area. Evidence in Level IV is based on personal experience. This is the least desirable source of evidence and lacks any statistical validity.

There is good evidence (e.g., from RCTs) and there is bad evidence (e.g., from personal experience). Then there’s evidence that falls in the grey area—neither clearly defined as good nor bad. It can be difficult for clinicians to know whether to use evidence in the grey area. To determine the validity of evidence, a team of clinicians with several years of experience in evidence-appraisal should review the knowledge in question. The team can then determine if the evidence is valid (i.e., accurate) and applicable (i.e., useful for the situation or population being considered).

COVID-19 is a fast moving epidemic with many uncertain parameters. In view of the lack of prior knowledge and urgency of the situation to have some understanding, clinicians and researchers worldwide are reporting rapid results in the form of Level III and Level IV evidence. There is no evidence at Level II or Level I about any treatment protocols at this time. These rapidly reported results are continuously changing as new insights on the SARS-CoV-2 virus and COVID-19 emerge.

The treatment protocols adopted by allopathy for treatment of COVID-19 have therefore been non- standardized, non-evidence-based protocols. They have been based on near real-time data, mostly of level IV and level III, to make care decisions with the sole objective of improving outcomes of treatment. Given the urgency for action, transparency, accountability, quality of care and value of care have expectedly taken a back seat.

Numerous preventative strategies and non-pharmaceutical interventions have been employed to mitigate the spread of disease including careful infection control, the isolation of patients, and social distancing. Management is predominantly focused on the provision of supportive care, with oxygen therapy representing the major treatment intervention. Medical therapy involving corticosteroids and antivirals have also been encouraged as part of critical management schemes.

The COVID-19 Treatment Guidelines have been developed by National Institutes of Health of the Government of the United States, to provide clinicians with guidance on how to care for patients with COVID-19. As per the official website these treatment guidelines were last updated on 27 May 2021. (https://www.covid19treatmentguidelines.nih.gov/introduction/ accessed on 06 June 2021). The recommendations in these Guidelines are based on scientific evidence and expert opinion. Each recommendation includes two ratings: an uppercase letter (A, B, or C) that indicates the strength of the recommendation [Rating of Recommendations: A = Strong; B = Moderate; C = Optional] and a Roman numeral with or without a lowercase letter (I, IIa, IIb, or III) that indicates the quality of the evidence that supports the recommendation [Rating of Evidence: I = One or more randomized trials without major limitations; IIa = other randomized trials or subgroup analyses of randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion].

As on date, there is only one recommendation rated ‘AI’ for Managing Outpatients with COVID-19 while the most reliable of recommendations for Managing Patients in an Ambulatory Care Setting have not bettered the ‘AIII’ rating. Critical Care recommendations are still at rating B. Recommendations for managing hospitalised patients with varying severities of disease are still at ‘BIIa’ rating.

These guidelines have a clear disclaimer, “Rated treatment recommendations in these Guidelines should not be considered mandates. The choice of what to do or not to do for an individual patient is ultimately decided by the patient and their provider.”

The above facts clearly indicate that there is no evidence-based-practice or evidence-based-protocol for treatment of COVID-19 in the allopathic system. Based on frugal, confusing, rapidly changing and often low-quality data, clinicians are using and recommending their best educated guesses for treating COVID-19. It is true that an educated guessing is better than no guessing until such time that research becomes available but there is no evidence to show that an educated guess is any better than an uneducated guess.

Surely you are joking Dr. Jayesh Lele when you say that the treatment-protocols being practiced for treatment of COVID-19 is evidence-based-medicine. There is no harm however in your and your fellow members of IMA at least hearing C. Miller when he tells us, “why the practice of medicine is not science.” (Miller C. “Medicine Is Not Science: Guessing The Future, Predicting The Past” Journal of Evaluation in Clinical Practice, 2014, Vol 20, Issue 6, pp. 865-71).

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First published 06 June 2021

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We Are Not Letting the Pandemic Weaken

The actual number of people getting sick with the coronavirus is increasing. We know this because in addition to positive COVID-19 tests, the number of symptomatic people, hospitalizations and later, deaths, are following the same pattern. Thankfully, Doctors, clinics and hospitals have learnt to reduce the fatality rate amongst the COVID-19 patients but this is no reason for people to throw caution to the winds.

Human behaviour is the major factor. State and local administrations, as well as individual people, differ in their response to the pandemic. Some follow COVID-19 precautions, such as physical distancing, hand washing and mask wearing. Others are not as prescriptive in requiring these measures or in restricting certain high-risk activities.

In some states and communities, public places are closed or practicing limitations (such as how many people are allowed inside at one time); others are operating normally. Some government and community leaders have encouraged or even mandated mask wearing and physical distancing in public areas. Others have left it as a matter of personal choice. In areas where fewer people are wearing masks and more are gathering indoors to eat, drink, observe religious practices, celebrate and socialize, even with family, cases are on the rise.

As state governments began to reopen cinemas, bars, restaurants and stores during the last few months, people were understandably eager to be able to go out and resume some of their normal activities. Nevertheless, the number of people infected with the coronavirus was still high in many areas, and transmission of the virus was easily rekindled once people increased their activities and contact with each other. Unfortunately, the combination of reopening and lapses in the infection prevention efforts – social distancing, hand washing and mask wearing – has caused the number of coronavirus infections to rise again.

There is a lag between a change in policy, and the effects of this change showing up in the COVID-19 data. An increase in the number of COVID-19 cases or hospitalizations is seen as many as six to eight weeks after change in policy. When a person is exposed to the coronavirus, it can take up to two weeks before they become sick enough to go to the doctor, get tested and have their case counted in the data. It takes even more time for additional people to become ill after being exposed to that person, and so on.

Several cycles of infection must occur before a noticeable increase shows in the data that public health officials use to track the pandemic. Due to such delays, people become careless with their behaviour, and they start moving around more. If everyone continues to wear masks, wash their hands and practice social distancing, reopening will have a much lower impact on transmission of the virus than in communities where people do not continue these safety precautions on a widespread basis. Also, after many months of cancelled activities, economic challenges and stress, people are frustrated and tired of taking coronavirus precautions. All these are factors that are driving surges and spikes in COVID-19 cases.

About 70% of the population needs to be immune to this coronavirus before herd immunity can work. People might be immune from the coronavirus, at least for a while, if they have already had it, but we do not know for how long such immunity lasts. A widely available, safe and effective vaccine is still going to take months for everyone to get it.

There is an alarming spike in the number of cases and more COVID-19 surges are likely to occur. Letting the coronavirus circulate freely among the public would result in hundreds of thousands of cases and millions more people left with lasting lung, heart, and brain or kidney damage. We must all continue to practice COVID-19 precautions, such as physical distancing, hand washing and mask wearing. We must work with our government to ensure that everyone in our household is up to date on vaccines as soon as they are made available.

Let no one harbour the false attitude of denial that COVID-19 does not happen to them or that they are not the spreaders of the infection once they have survived COVID-19 or have been vaccinated for it. 

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the COVID-19 disease but people are the cause of the pandemic.

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First published 12 April 21

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This is my India. I love my India.

I was one of the lucky ones among the ‘age over 60 years’ category to receive the first dose of the COVID-19 vaccine at a private hospital on 01 March 2021 itself. I am grateful to our scientists, health workers for their race against time to deliver the vaccines to people. I am equally grateful to Government of India for making it accessible to us.

Two observations from the vaccination centre while I was waiting for my turn and then being under observation for 30-minutes after the injection are interesting for sharing here. Both of them relate to the group ‘age between 45 and 60 years with co-morbidities.’

In one case, family of someone in this category of ‘age between 45 and 60 years with co-morbidities’ did not want to be vaccinated by declaring the ‘co-morbidities’ because they feared that the health insurance premium would go up if they disclosed the existing diseases.

In the second case, someone in the ‘age between 45 and 60 years but without any co-morbidities’ used a false medical certificate declaring a co-morbidity to receive the vaccine.

I am not standing in any moral judgment for either of the cases because these cases did not surprise me as Javed Akhtar had penned in his hit song FIR BHI DIL HAI HINDUSTANI. Even the experiments conducted by Dan Ariely (James B. Duke Professor of Psychology and Behavioral Economics at Duke University) in India and on Indian people and reported by him in “The Upside of Irrationality (Harper 2010)” and “The Honest Truth About Dishonesty (Harper 2013)” show that up to 6% of dishonesty is not even considered as dishonesty by us. I hope, not more than 6% of us fudge the truth about our medical conditions.

I am however anticipating something different. We being Indians are used to hiding our existing medical conditions for the fear of being social ostracized or being pitied at. However, some of us may now falsely declare to be having medical conditions to get the vaccine out of turn.

Will the post-vaccination data erroneously show that the citizens ‘aged between 45 and 60 years have unusually low or high incidence of co-morbidities’ in India or such aberrations will statistically cancel each other out?

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First published 02 March 2021

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Some Unsought Advice for the Prime Minister Shri Modi

The situation where you are running from pillar to post to find a hospital bed or an oxygen cylinder for your loved one, and there is nowhere to go, you feel frustrated, helpless and angry.  If you are the lucky one to find some place, the ban on visitors makes you more edgy because you could not be with your loved one to offer comfort and support when he/she needed it most. The thought of not being able to see or comfort a loved one who is living with an advanced illness is heart breaking.

Time seems to freeze when you learn that someone you love has slipped from medical care to critical care in a COVID-19 facility. Maybe you instinctively pushed the news away, or perhaps you cried, or swung into action. You and your loved one may have pursued promising treatments and perhaps enjoyed some respite from the illness over the last few days.

The loss of a loved one is life’s most stressful event and can cause a major emotional crisis. All kinds of emotions, denial, disbelief, confusion, shock, sadness, yearning, anger, humiliation, despair, guilt, can flood people’s minds.

SUCCESS, WHICH THE GOVERNMENT IS TRUMPETING

The data given out by Ministry of Health and Family Welfare website https://www.mohfw.gov.in/.

COVID-19 CASES IN INDIA as on: 15 May 2021, 08:00 IST (GMT+5:30)

Active – 3673802   Discharged – 20432898    Deaths – 266207    

Until date (15 May 2021), 24372907 people have been identified to be infected, of which 15.07% (3673802) are Active cases right now, 83.83% (20432898) have successfully survived the infection but unfortunately, the balance 1.09% (266207) could not survive and have died.

Yes, your government is right that Indian has done exceedingly well, on an aggregate basis, in management of the COVID-19 crisis as compared to any of the countries in the world. Nevertheless, the fact remains that the mismanagement of second wave of COVID is hidden behind the exemplary management of the COVID. Your government was successful in flattening the curve of cases and deaths of the first wave over a period of 11-months, something which the Western world could not do. The same cannot however be said for the second wave.

FAILURE, WHICH OVERWHELMED INDIA

You do not have to go to any other source of data to see this. Failure, which overwhelmed India, is buried, not too deep, in these very numbers.

Please have a relook at the data given out by Ministry of Health and Family Welfare website https://www.mohfw.gov.in/.

COVID-19 CASES IN INDIA as on: 15 May 2021, 08:00 IST (GMT+5:30)

Active – 3673802   Discharged – 20432898    Deaths – 266207    

COVID-19 CASES IN INDIA as on: 15 April 2021, 08:00 IST (GMT+5:30)

Active – 1471877   Discharged – 12429564    Deaths – 173123    

Of the 24372907 people identified as infected so far (over the last 15 and one half month – the first case was reported on 30.01.2020), 10499082 (43.08%) cases came during the last one month. Out of 266207 deaths recorded so far, 94122 (35.36%) deaths occurred during the last one month.

This is not a joke or a mere spike. It is a deluge.

Of all the cases – 43% came in last one month;

Of all the people dying – 35% died in last one month.

COVID-19 began hitting way too close to everyone’s home. What were merely numbers for people during the first wave, started turning into names and those names 𝗂𝗇𝗍𝗈 real 𝗉𝖾𝗈𝗉𝗅𝖾 whom people know?

WHAT WENT WRONG

With micro-situations continuously evolving and rapidly changing, managing Pandemics at the ground level is a very complex phenomenon involving case-by-case tactical and urgent decisions that need ‘thinking fast’. However, the policy level, at which the office of the Prime Minister sits, the foresight and strategy based thereon, is an important decision that allows wider consultations, reviews and ‘thinking slow.’

At the strategy level, dealing with pandemics involve only two sub-strategies, ensuring that the pandemic does not spread (Restriction strategy) and ensuring that those infected are able to recover from the disease (Treatment strategy).

Restriction is about reducing the number of cases, which is accomplished through controlling the spread of infection (Appropriate Behaviour and immunisation through vaccines). Where the disease is contagious, isolation and quarantine of the prospect (contact tracing) and the suspect case (symptomatic cases) is as important as that of the confirmed case. In case like COVID, where not every infected person shows the symptoms of being infected (asymptomatic cases) the inter-people-contact has to be clamped down.

Treatment is about reducing the mortality rate among the cases through proper and timely diagnosis and treatment.

YOU HAVE RIGHTFULLY TAKEN CREDIT FOR MANAGING THE FIRST WAVE

You had the foresight and the promptness in March-April 2020, in using the Restriction strategy, when the first wave of the pandemic broke out, which resulted into definitive reduction in spread of infection and reduction in the mortality rates. Numbers speak for themselves.

However, the second wave, which started knocking at our doors towards the end of February 2021 and is peaking now, has left much to be desired at your level.

SHOW THE GRIT IN ACCEPTING THE DISCREDIT FOR MISMANAGING THE SECOND WAVE

COVID-19 patients tend to be sick for a long time, spending weeks in the intensive care unit in some cases. Patients improve up to a point, and then it can be several weeks before one would see them continue to improve. Families need to prepare for that, as well as peaks and valleys seen so often in the sickest patients. Hospital restrictions that prohibit visiting COVID-19 patients have been major stressors for families, as well as those in the hospital. In the unfortunate events of patients losing the fight against COVID-19, not every one of their families and friends have the emotional strength of suffering the pain sagaciously or silently. Patients, their families, and other caregivers have little patience or tolerance, and their short fuses can explode on the very people trying to care for them.

Doctors and nurses are withstanding the worst of a much angrier, more frustrated, and weary bunch. Medics falter when they witness rudeness and other bad behaviour. It interferes with their working memory and decreases their performance. Frustrated patients are making health care workers’ jobs even harder.

No medical-care infrastructure, in terms of both physical dimensions and human dimensions, can have the capacity to deal with such deluge.  No society can cope with such agony and death. Yes, Treatment Strategy has limitations in dealing with such tsunami of cases.

However, you have faltered in making use of the Restriction Strategy once the coming of the second wave was clearly visible towards the end of February 2021. This failure has resulted into the ‘unforeseen’ deluge of cases and deaths. In ability to see these coming, is itself a failure of leadership and his advisors.

Overtly or covertly, this failure is being attributed not to any lack of your foresight regarding COVID, but to your political ambitions in West Bengal and other states. I am not a political strategist, but the results tell us a story.

FAILURE IN STATE ELECTIONS 2021

Ever since you brought in the US Presidential style of electioneering to Indian politics in 2014, people vote for the leader as much as they vote for a party. Your inability to win Rajasthan, Punjab, Maharashtra and Madhya Pradesh had shown an association in your inability to project an unambiguous leader who could campaign in the same style in the state as yours in the national elections.

When you or any of your central leaders campaign in a state election, the electorate asks themselves – are you or any of those central leaders going to be their Chief Minister? Even when they wish to vote for your party, they do not know who is going to rule them. As they say, a known foe is better than an unknown friend is, the electorate ends up making choices, which may look poor from a larger perspective, but they are the best picks that the electorate could make from within the choices available to them.

Let us not forget that a day after the first round of polling took place on 20 May 1991, former Prime Minister Rajiv Gandhi was assassinated while campaigning. The remaining election days were postponed until mid-June and voting finally took place on 12 and 15 June. When the surge in COVID cases was so visible by the end of March for everyone to see, not postponing the elections was neither good strategy nor good politics. The votes polled in your favour in successive rounds of polling have shown a negative association with the rising COVID-cases in the country. Who knows, if the state elections were postponed for a better time, their results for you could have been better.

WHAT NEXT

Dear Prime Minister! As a leader, please accept the fact that you won the battle against the first wave but lost the battle against the second wave. You do not win all the battles. It is important that you win the war – war against COVID-19.

You won people’s mandate because they trusted you. You used your high visibility and high credibility in winning over their emotions. Trust is after all an emotion.

All Indians are one but they are not the same. Similar people are grouped into states. That we have 29 states shows similarity of people within the states but dissimilarity of people across the states. Indians are not like Americans, who have little diversity in language, culture or religion.

The unified central-command structure of decision making which you could use so successfully in running the Government in Gujarat may not be an optimal design for running the Union Government. Please remember that the entire bureaucracy that you handled in Gujarat was a unified Gujarat cadre but when you handle the union Government, your bureaucracy is not one cadre. The rules of engaging with the opposition leaders and bureaucracy within Gujarat are not suited to engaging with the opposition leaders and bureaucracy in the matters of the Union.

They still trust you but the untold agony and death, which they have seen over the last one month, has broken them emotionally. Fear & grief of COVID-19 is overwhelming ordinary people and your political rivals and bruised media (you have taken away many of their free bees) are adding fuel to this fire. Emotions are contagious. Our brains are wired to mirror the body language and emotion of others. In an era of social media, opinions occlude information and truth becomes matter of opinion. Absolute truth makes way for pre-truths, half-truths, developing truths, post-truths, my truths, your truths and no-one-knows whose-truth.

There is no denying that you are suffering from a loss in your credibility. Your high visibility and waning credibility is untenable in public space. You cannot be complacent or disheartened. You need to make a serious course-correction.

You have to rise as a leader and restore the confidence of people in their ability to overcome and succeed under your leadership. Please work towards decreasing the COVID-19 test-positivity rate & case fatality rate and increasing the EMOTIONAL POSITIVITY among the people of India.

To everyone locked inside their homes, in fear or anxiety, and to everyone locked out from the joys of life as usual, please put a confidence in them that the sun will come again. Remind them of the vibration that passed all over their lives, make them remember everything that they shared with their loved ones, thank the Gods who helped them face the untold grief over the last one month.

You have to rise from the ashes of the second wave. YOU HAVE TO WIN ALL THE FORTHCOMING BATTLES AGAINST THE THIRD AND THE FOURTH WAVE. YOU HAVE TO WIN THE WAR.

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First Published 17 May 2021

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Na Dainyam Na Palayanam न दैन्यं न पलायनम्*

There is no reason to believe that any Indian political leader is anti-India. They all mean well and wish well of the country. They all have illusionary visions and Indian spirituality.

The phrase ‘Vasudhaiva Kuṭumbakam’ (Sanskrit: वसुधैव कुटुम्बकम्) consists of several words: vasudhā (transl. ’the earth’); ēva (transl. ’is thus’); and kuṭumbakam (transl. ’family’).

अयं निजः परो वेति गणना लघुचेतसाम्। (ayaṃ nijaḥ paro veti gaṇanā laghucetasām)

उदारचरितानां तु वसुधैव कुटुम्बकम्॥ (udāracaritānāṃ tu vasudhaiva kuṭumbakam)

The original verse appears in Chapter 6 of Maha Upanishad VI.71-73. Also found in the Rig Veda, it is considered the most important moral value in the Indian society. This verse of Maha Upanishad is engraved in the entrance hall of the parliament of India.

‘Vasudhaiva Kuṭumbakam’ belonged to the world where there was only the Vedic Civilisation and is no more valid in the times of ‘I, me, mine and ours’ ethos. A Hindu may believe that the whole world is ‘one family’ but the rest of the 85 percent of the people of the world may not think so.

Nehru misread China, Shastri misread Pakistan, Indira misread Khalistan, Guljari Lal, Morarji, Charan Singh, VP Singh, Gujaral, Devegowda, and Chandra Shekhar were unable to read anything, Rajiv misread Sri Lankans, Narsinha Rao misread Italians, Vajpayee misread Pakistan, ManMohan did not read anything, and Modi has misread China.

All politicians know and understand that ‘poverty’ is India’s biggest problem. Most of them want to correct it but they do not have it in them to deal with the problem directly. Indian political leadership has conclusively proven itself consistently deficient in its foresight and capability in policy-making and action taking over the last 75 years. 

If India lost the 1962 war with China, due to lack of appropriate weapons and ammunition in the hands of our soldiers, India may lose the 2020-21 war against this virus due to lack of appropriate weapons and ammunition in the hands of our doctors.

A wiser political leader Vajpayee had written:

कर्तव्य के पुनीत पथ को
हमने स्वेद से सींचा है,
कभी-कभी अपने अश्रु और—
प्राणों का अर्ध्य भी दिया है।

किंतु, अपनी ध्येय-यात्रा में—
हम कभी रुके नहीं हैं।
किसी चुनौती के सम्मुख
कभी झुके नहीं हैं।

आज,
जब कि राष्ट्र-जीवन की
समस्त निधियाँ,
दाँव पर लगी हैं,
और,
एक घनीभूत अंधेरा—
हमारे जीवन के
सारे आलोक को
निगल लेना चाहता है;

हमें ध्येय के लिए
जीने, जूझने और
आवश्यकता पड़ने पर—
मरने के संकल्प को दोहराना है।

आग्नेय परीक्षा की

इस घड़ी में—
आइए, अर्जुन की तरह
उद्घोष करें:
‘‘न दैन्यं न पलायनम्।’’

A ‘Murali-Dhar’ does not remain a ‘Murali-Dhar’ but goes on to become a ‘Giri-Dhar’ and a ‘Chakra-Dhar’ as the situation requires.

If ‘Maha Upanishad’ gives us, the value of ‘Vasudhaiva Kuṭumbakam,’ ‘Katha Upanishad’ gives the inspiration to Swami Vivekananda to give us ‘Arise, awake, and stop not till the goal is reached.‘ The words “Arise, awake…” can be found in the 1.3.14 chapter of the ‘Katha Upanishad’, where Yama is advising Nachiketa

उत्तिष्ठत जाग्रत प्राप्य वरान्निबोधत, (Uttisthata Jagrata Prapya Varannibodhata)
क्षुरासन्न धारा निशिता दुरत्यद्दुर्गम पथ: तत् कवयो वदन्ति| (Kshurasanna Dhara Nishita Durataya durgama Pathah tat kavayo Vadanti)

Arise! Awake! Approach the great and learn.
Like the sharp edge of a razor is that path,
so the wise say—hard to tread and difficult to cross.

* न दैन्यं न पलायनम् was the motto of my school that I proudly wore on the badge of my barrette cap.

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First published 27 April 2021

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Crush the Enemy Within

A careful examination of the reactions of the civil-society; the secularists, and the reporting by the media connected with the “incidents and events” in India, over the last 28 years, beginning with the 1993 Mumbai blasts shows a very hypocritical prejudice. When those seen as perpetrators of the crime were Muslims, the standard line was, “terrorism has no religion.” And there were numerous instances of the kind. However, in an exceptional instance, where the crime could be attributed to Hindus; the untoward event was showcased as unassailable “Hindu Terrorism.”

To kill even the imagery of “killing for or in the name of religion” Hindus are possibly the only people in the world, who, rather than kill, have got killed. They have never attacked anyone for propagating their religion. Hindus have welcomed people of all nationalities, faiths and cultures, when they came pursuing their personal, logical dreams and aspirations. Only under a threat to their own survival caused by a “Fire & Sword” tenet of the external aggressors, did the Hindus invoke “Maa Kali” to rekindle their sacrificial fire and then did not stop until they have driven the aggressors back to where they came from.

Christian or Muslim, though they have just recently converted and still have lots of Hindu content in their spiritual lives, somehow believe that they belong to a cultural unit altogether different form the Hindu one. Hindustan to them is where they live, yet it is not Holy land to them, which is far off in Arabia or Palestine. Naturally therefore, their love is divided. They must set their Holy-land above India in their love and allegiance. It is however, a folly, when Indian Muslims start looking at Pakistan as their fatherland and/or holy-land. If the majority of the Indian Muslims can free themselves from their prejudices coming from such ignorance, and as the patriotic and noble – minded amongst them have always been doing; and begin to love Hindustan as their fatherland, the story of their conversions, forcible in millions of cases is too recent to make them forget . . . that they inherit Hindu blood in their veins.

If a Sister Nivedita or an Annie Besant could become a Hindustani in spite of being from a different Nation (rashtra), Race (Jati), Civilization (Sanskriti) and Holy land (pavitra bhoomi); Hindu-ness must be something more profound than the what it is being made out to be by the propagators  of the malicious scare of “Hindu-Terror.” This propaganda gives fire to the deviant and the misled to form into scattered hooligan groups adorning the “saffron” and creating mischief. All these are rudderless groups of young people out seeking media limelight through acts of misplaced adventurism. They are ‘rogues and goondas’ exhibiting a religious fervour at the most, not necessarily driven by religion; some of them neither Hindus nor with Hindu names; but for sure, not terrorists.

Unfortunately, there are no external aggressors and there is no “fire & sword” tenet in the present day attacks on Hindu-ness of India which has always stood for universal peace and brotherhood. The aggressors are enemies within; and they are using the tenets of “propaganda, unrest and division.” They are not the enemies of Hindus or friends of Muslims. They are simply bigoted, selfish, blood-thirsty hyenas waiting to feast on the remnants of the wealth and flesh of India, which they believe would fall prey to the roaring lion of “Maa Kali” or the ‘tandava’ of “Bhagawan Shiva”

True Hindus are trying their best, as they ought to do, to develop the consciousness of and a sense of attachment to the greater whole, whereby Hindus, Muslims, Parsis, Christians and Jews would feel as Indians first and every other thing afterwards. But whatever progress India may have made to that goal one thing remains almost axiomatically true – not only in India but everywhere in the world – that a nation requires a foundation to stand upon and the essence of the life of a nation is the life of that portion of its citizens whose interest and history and aspirations are most closely bound up with the land and who thus provide the real foundation to the structure of their national state.

Multiple ethnicity and religiosity is the strength of India. This provides cultural and social diversity, variety and enrichment within the mega space called Bharat. Hindutva or Hindu-ness is plural and should not be mistaken as a synonym for Hindu-religion. Yet India needs cleansing in the nature of weeding out of the enemy within. It is unfortunate that most of such enemies have Hindu names and origins. They are deep in a new kind of “Intellectual terrorism.”  Indians and Hindus cannot drink with equanimity this cup of bitterness and political servitude at the hands of those whose only aspiration is to feast on the putrefied flesh from the corpse of Hindustan. Whenever under aggression, Hindustan has looked to Vedic wisdom. “Arise, awake, and stop not till the goal is reached” is a shloka of Katha Upanishad which was popularized in the late 19th century by Swami Vivekananda.

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Multiple sources of like-minded thought are humbly acknowledged for the above expressions. First published 25 Feb 2021

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