US President Donald Trump’s declaration that he was taking an antimalarial drug of dubious effectiveness to help fend off the coronavirus will likely be welcomed in India.
Trump's previous endorsement of hydroxychloroquine catalyzed a tremendous shift in the South Asian country, spurring the world’s largest producer of the drug to make much more of it, prescribe it for front-line health workers treating the virus and deploy it as a diplomatic tool, despite mounting evidence against using the drug for COVID-19.
Trump said Monday that he was taking hydroxychloroquine as a measure of protection against the virus. The U.S. Food and Drug Administration, however, has cautioned against using it outside of hospitals because of the risk of serious heart problems.
Suhhil Gupta, a pharmacist in New Delhi, said Tuesday that Trump's announcement shouldn't carry any weight in India.
“He's not a pharmacist. His statements are not relevant to the field,” Gupta said.
Still, India’s policy on the decades-old drug, used to prevent malaria and treat lupus and rheumatoid arthritis, drastically changed after Trump tweeted in March that the drug, used together with an antibiotic, could be “game changers” in the fight against the pandemic. India’s health ministry quickly approved it as a prophylactic for health care workers and others at high risk of infection, and as a treatment for critically ill patients.
Officials in Mumbai even drew up a plan to administer hydroxychloroquine to thousands of slum dwellers as a preventive measure against the virus.
Indian health officials have declined repeated requests for comment, limiting communications to daily health briefings, the last of which occurred May 11.
The rules say that drugs such as hydroxychloroquine be used only after a rigorous scientific and ethical review, continued oversight by an ethics committee and ensuring informed consent — none of which happened with HCQ, according to Dr. Amar Jesani, a medical ethics expert.
The Mumbai proposal was ultimately shelved amid questions of the ethics of administering HCQ, as the drug is known, without first subjecting it to clinical trials. Still, the Indian government has recommended more and more people use it, contravening 2017 rules for emergency use of untested drugs, Jesani said.
India initially banned HCQ exports, but lifted the ban after Trump threatened “retaliation.” At the same time, India's government ordered manufacturers to ramp up production from 1.2 million to 3 million pills a month — causing company shares to skyrocket. From the U.S. to Australia, sales jumped.
Officials have even said that Indian plantations could increase the growing capacity of cinchona trees, whose bark contains the compound quinine, which has been used to treat malaria since the 1860s. Quinine can also be made synthetically.
The Indian government itself purchased 100 million HCQ pills, according to government data, to distribute to states and donate to countries including Afghanistan, Myanmar and the Dominican Republic.
India is the world’s largest producer of generic drugs, a fast-growing industry that has brought down pharmaceutical prices globally. During the HIV/AIDs crisis, India played a similar role as in the coronavirus pandemic, boosting global supplies of life-saving drugs.
The problem this time, experts say, is that the hydroxychloroquine hype is based on a flimsy study, with little to no evidence that it prevents or treats COVID-19.
Still, a sharp rise in demand has reduced supplies for patients with lupus and rheumatoid arthritis.
India’s hurried guidance has also impeded scientific trials that could determine whether the benefits of taking HCQ outweigh the risks.
“We should do a trial. I think that is the right way to come to answer on this question. But the (government) made our job harder,” said Dr. Bharath Kumar, whose team has proposed a trial.
Meanwhile, evidence against using HCQ for the coronavirus is growing.
A U.S. study of 368 patients in veterans’ hospitals, the largest study yet examining HCQ’s value as a coronavirus antidote, found no benefits and even more deaths among those given the drug.
The Indian government’s own assessment of 19 drugs found that HCQ wasn’t the most promising. A task force noted that while HCQ was readily available, the strength of scientific evidence for the mechanism of action was fairly low.
Vatel Thailand, a partnership between France’s Vatel Hotel & Tourism Business School and Thailand’s Silpakorn University, are accepting applications for the August 2020 intake of its BBA in Hotel Management, an international double degree program preparing students for a successful career in the hotel and tourism sector, with a new option to graduate in 3 years.
Vatel Thailand’s BBA curriculum offers the right balance between academic theory and practice in professional training at the school, including Vatel Restaurant and Café, said Asst. Prof. Dr. Sompid Kattiyapikul, Dean of Silpakorn University International College and Director of Vatel Thailand. Most importantly, students conduct at least two internships at partner hotel chains in Thailand and throughout the world.
“To Asian students, we are offering the quality of an internationally recognized program, in a friendly environment, close to home,” Dr. Sompid said.
“This is a challenging year for tourism globally, but international hotel chains are continuing to expand in Asia and so it’s important to study the right courses to cope with the dynamic employment demands of the profession
once things return to normal.”
Vatel, established in France in 1981 by Mr. Alain Sebban, is the 1st Worldwide Business School Group in Hospitality & Tourism Management with 51 schools across four continents, providing students the opportunity to participate in
the Marco Polo exchange program. Since 2003, over 1,500 students have graduated from Vatel Thailand.
The theory classes, all taught in English by an international faculty, range from hotel entrepreneurship and innovation, hospitality in the 21st century, marketing, and business planning, to international tourism economy, human resources, cross cultural management, and service psychology. The students can also take Chinese and French lessons.
Upon completion, students receive two internationally accredited degrees from Vatel and Silpakorn University. Those wishing to enter professional life quickly, can complete the program within 3 years, instead of 4.
Vatel Thailand provides state of the art classrooms and facilities which are also capable of delivering online academic classes.
More than 35,000 Vateliens, as Vatel alumni are called, can be found working in management in 5- star hotels around the world, forming a dynamic, strong and priceless network.
For the program starting on 31st August 2020, applications are open until 31st July. Scholarships are available.
SOURCE: Vatel Thailand
India relaxed some coronavirus lockdown restrictions on Monday even as the pace of infection picked up and reopenings drew crowds of people.
The near-total 5-week lockdown on India's 1.3 billion population achieved a slowdown in the spread of the virus but has caused immense hardship for India's legions of poor people, who could neither stay in cities without work nor travel to their home villages and waited in line daily for hot meals. Some degree of lockdown will continue at least until May 18.
A tentative return to normal life, albeit with masks, social distancing and stringent hygiene standards, resumed in low-risk areas with few or no cases, while constraints on movement and work continued elsewhere in the country. In New Delhi, a designated hot spot where many lockdown restrictions remained, construction workers, Uber drivers and self-employed people such as housekeepers returned to work.
During the lockdown, only businesses deemed essential, such as grocery stores, banks and pharmacies, were open. The sale of alcohol was banned. But on Monday, a broader array of business was permitted. More than 100 people, not all observing social distancing norms, stood in line to enter a liquor store.
At another liquor store in Old Delhi, a usually highly congested area around the Mughal-era Red Fort, about 200 would-be shoppers pushed and shoved each other to enter. Police wielded their bamboo batons to break up the crowd.
Neeraj Mehta went to a liquor store in East Delhi, but the crowd scared him off. "The government should just keep the liquor shops shut if such crowds are going to gather," he said.
Migrant workers who fled Indian cities en masse when the lockdown took effect March 25, only to become stranded on the road and quarantined by state governments, were traveling by special rail service to their home villages. The Railways said it would charge a highly subsidized rate, but opposition political leader Sonia Gandhi said the Congress party would cover the cost.
"Thousands of migrant workers and laborers were forced to walk home several hundred kilometers on foot without food, without medicines, without money, without transportation, without anything but the desire to return to their families and loved ones," Gandhi said in a statement.
Still, the infection rate was growing at 5.5% compared to 4.7% two day ago, according to the Brookings Institution think tank.
"Active cases now growing at 5.5%, so doubling every 13 days. Not good. Hotspot management (containment and contact tracing and testing) needs to be much better," tweeted Shamika Ravi, a Brookings Institution fellow.
India reported 42,500 virus cases, 11,706 recoveries and 1,373 deaths, and had tested more than a million samples by Monday. Still, at 758 tests per million, India was among the countries testing the lowest fraction of their population. And experts warn that the virus has yet to peak.
The spread of the coronavirus in India's notoriously crowded prisons has prompted authorities to impose jail lockdowns and release thousands of pretrial detainees on parole, as health experts worry that the cramped facilities are serving as breeding grounds for the disease.
Although there are no official numbers on how many inmates have been infected by the virus, India's correction facilities are slowly recording more infections and have temporarily banned visitors.
On Thursday, authorities locked down Nagpur Central Jail in coastal Maharashtra, among the Indian states worst hit by the pandemic. It was the eighth prison in Maharashtra to be locked down. The move came after 19 inmates in Indore Central Jail in central Madhya Pradesh state tested positive for the virus on Tuesday. Around 250 others who came in contact with them were shifted to a temporary jail.
"It is a terrifying situation. If measures aren't taken soon, then things can become extremely difficult," said Madhurima Dhanuka, head of the Prison Reforms Program for the Commonwealth Human Rights Initiative.
Considering its population of 1.3 billion, India has done relatively well so far in containing the coronavirus, confirming around 37,000 infections, including 1,223 deaths. On Friday, the government extended the lockdown it had announced in late March for another two weeks, but eased restrictions in some low-risk areas and is now trying to gradually reopen some industries, including agriculture and manufacturing.
Health experts, however, fear that crowded facilities such as prisons can prove deadly, threatening the lives of detainees and guards, as well as the outside population.
The virus has spread rapidly in overcrowded prisons across the world, leading governments to release inmates en masse. United Nations experts and the World Health Organization have urged governments to reduce their prison populations during the pandemic.
In the Philippines, which has some of the most congested jails in the world, a Supreme Court justice said Saturday that nearly 10,000 poor inmates had been temporarily freed by reducing the amounts of their bails.
Some of the inmates, who could not afford to post bail, were released to the custody of local officials, underscoring the urgency to ease overcrowding in jails.
In March, India's top court said that it was "difficult for prisoners to maintain social distancing" and ordered that detainees convicted of crimes with jail terms of no more than seven years be given parole. Many states started releasing thousands of inmates.
Attempts to reduce the prison population, however, were not enough, critics say.
Indian prisons are highly overcrowded. According to the latest data by the National Crimes Record Bureau in 2018, India has some 450,000 prisoners, exceeding the country's official prison capacity by about 17%. Prisons in New Delhi and neighboring Uttar Pradesh state have the highest occupancy rates, at over 50% above capacity.
Making matters worse, "the health facilities in prisons are not up to the mark," said Dhanuka.
The official data shows that only 4% of total prison expenditure was spent on inmates' medical needs in 2018. It also shows a 40% shortage of medical personnel in Indian prisons.
Dhanuka said the combination of a low health care budget, a shortage of doctors and "horrible hygiene facilities" has created ideal conditions for the coronavirus to spread in prisons.
While the government said it already has released thousands of prisoners and plans to set more free, worried families whose loved ones are still in jail are distraught.
In April, the family of Mian Qayoom, a 73-year-old human rights lawyer from disputed Kashmir who is locked up in New Delhi's Tihar jail, wrote to authorities to urge them to release him on parole due to his ailing health. The family said that Qayoom was a diabetic with a serious heart condition.
But on April 29, the Indian government said that Qayoom's release was not covered in the guidelines issued by the country's top court.
Qayoom was arrested in August under the Public Safety Act, which allows people to be held for up to two years without trial.
"He is most prone to this virus attack," said Qayoom's nephew, Mian Muzaffar, who is also his lawyer. "It's a death sentence to keep him inside India's most notorious and one of the most crowded jails in these times."
India has extended its lockdown for a further period of two weeks beyond May 4.
After a comprehensive review and in view of the lockdown measures having led to significant gains in the COVID-19 situation in the country, Indian Ministry of Home Affairs issued an order under the Disaster Management Act, 2005.
The Indian Military also issued new guidelines to regulate different activities during this period, based on the risk profiling of the districts of the country into Red (hotspot), Green and Orange Zones.
The guidelines have permitted considerable relaxations in the districts falling in the Green and Orange Zones.
The criteria for identification of districts as Red, Green and Orange Zones have been spelt out in detail in the letter dated April 30, 2020, issued by the Ministry of Health and Family Welfare (MoHFW), GoI.
People who arrived from neighboring Madhya Pradesh state wait to board a bus to be transported back to their native homes in Uttar Pradesh state in Prayagraj, India.AP Photo
The Green Zones will be districts with either zero confirmed cases till date; or, no confirmed case in the last 21 days.
The classification of districts as Red Zones will take into account the total number of active cases, doubling rate of confirmed cases, extent of testing and surveillance feedback from the districts.
Those districts, which are neither defined as Red nor Green, shall be classified as Orange zones.
The classification of districts into Red, Green and Orange Zones will be shared by MoHFW with the States and Union Territories (UTs) on a weekly basis, or earlier, as required.
While States and UTs can include additional districts as Red and Orange Zones, they may not lower the classification of a district included by MoHFW in the list of Red or Orange Zones.