TWENTY

Twenty twenty,

Trouble aplenty.

Twenty twenty-one, 

Battle yet to be won. 

Twenty twenty-two, 

You’ll be vaccinated too. 

Slowly, slowly, we’ll see.

We’ll get there, maybe.

Protocol for Emergency Treatment of Anaphylaxis (after Covid-19 vaccination)

1. Patient to be observed for 30 mins in the clinic after Covid-19 vaccine (and patient to observe himself for 24 hrs at home).

2. Diagnose anaphylaxis.

-Urticaria, angioedema

-Dyspnea, wheeze

-Dizziness, syncope, hypotension

-Nausea, vomiting, diarrhea, cramping abdominal pain

-Flush

-Upper airway edema

-Headache

-Rhinitis

-Substernal pain

-Pruritus without rash

-Seizure

3. Call 995 immediately.

4. Place patient in recumbent position and elevate lower extremities, but treat patient sitting up if he is breathless.

5. Monitor vital signs frequently (every two to five minutes) and stay with the patient.

6. Administer adrenaline 1:1,000 (weight-based) adults: 0.01 mL per kg, up to a maximum of 0.2 to 0.5 mL every 10 to 15 minutes as needed; children: 0.01 mL per kg, up to a maximum dose of 0.2 to 0.5 mL by SC or IM route and, if necessary, repeat every 15 minutes, up to two doses.

7. Maintain airway with an oropharyngeal airway device. Administer oxygen (if you have), usually 8 to 10 L per minute; lower concentrations may be appropriate for patients with chronic obstructive pulmonary disease.

8. IM Piriton 1 ml stat.

9. IM Adrenaline 0.15 to 0.3 mL, into injection site (left deltoid) to inhibit further absorption of the injected substance (vaccine).

10. Set up IV line to treat hypotension with IV fluids.

11. Treat bronchospasm with Ventolin nebuliser 2 mls:1 ml saline stat.

12. Give IM hydrocortisone 100 mg stat or tab prednisone 20 mg stat orally in mild cases. This does not work immediately but reduces the risk of recurring or protracted anaphylaxis. These doses can be repeated every six hours, as required.

13. All fatal and life-threatening events are to be reported to HSA within 24 hrs and all other Severe Adverse Events and Adverse Events of Special Interest within 48 hrs online at https://www.hsa.gov.sg/adverse-events. Fatal events also are to be reported to the Coroner.

RUN

First you run 

Have some fun

Then you walk

Forget the talk

See no sun

Drop the gun

Stop the clock

Let them mock

You are done

Sleep you want

COVID FATIQUE

Have we lost our way?

Are we being led astray?

Which direction should we turn,

While behind, the bridges burn?

Everybody says: “stay positive,

Someday, there will be reprieve.”

But, the end of the road is near,

And the future is far from clear.

We seem to have missed the bus.

The gods are not smiling on us.

Providence has been found wanting, 

So, there is no end to the waiting.

We keep moving in a straight line,

With the blind leading the blind.

We don’t know who is asking who?

So, please tell me what to do.

21 July 2020

THAT’S ME!

Once you are born,

You refuse to die.

You want to go on

Till you touch the sky!

A MOMENT 

A moment to make a choice

For brave girls and big boys.

Make drama, make some noise,

Drown them out with your voice.

Timid hearts and weak minds flee

To maximum safety and security.

Eyes are open but we don’t see.

Are you seriously kidding me?

Mindsets and habits die hard,

For true facts we’ve no regard.

Just some things we can’t discard,

But please, don’t call me a retard!

We’re neither sick nor healthy

‘Cause the virus is so stealthy.

Without compassion or empathy,

Will your vote be true and worthy?

HOW TO LIVE GOOD, INDEPENDENT AND AUTHENTIC LIVES IN SINGAPORE:











                           Sorry, no, you can’t!     ....

A PERFECT MOMENT FOR AWAKENING

If you wanna do life less maddening,

Here’s a perfect moment for awakening.

The emperor certainly has no clothes, 

But sorry to say, we’re out of life boats.

What you have here is an unnatural life.

And at your neck there, an invisible knife.

You gotta be a good sport and a good tool,

So, obey every law and every little rule.

Under an illusion of control and certainty,

The outbreak has no risk of modesty.

With expert words so refined and sleek,

Their counsel you’re duty-bound to seek.

We wonder: when’s our Day of Reckoning?

When both freedom and justice are floundering

In a world of make-believe that’ll only imbue

That these things don’t apply to you!

America Today

Shallow pockets

Separate baskets

Wild rockets

Rampant caskets

Ticking clock

Leaders baulk

Big talk

Never walk

Broken arrow 

Wounded sparrow

Silent sorrow 

Where’s tomorrow 

LOCKDOWN BLUES

Wind-blown trees are a-swaying,

So, it’s no time to go out straying.

But when all I do at home is stay,

Today will be just like yesterday.

Lonely here in my quiet cabin,

There is not even a dropped pin.

I can no longer be happy or sad,

Because I think I’m already mad!

Safety is merely a place to hide.

But it’s full of emptiness inside.

While others brave the storm,

I sit here cursing the new norm.

A Swedish Gamble

We don’t wanna lose any sleep

Climbing up a hill so steep,

We don’t wanna dig too deep,

For the treasures we wanna keep.

We don’t use a woodpecker’s beak

Because the world is not so bleak.

No heart bleeds nor eyes leak,

It’s only safe shelter we seek.

We just want things to naturally flow.

Release the pressure and let it go.

From crowning head to tipping toe,

It’s a simple question of yes or no.

With no obvious solution to be found,

Let’s keep still, don’t make a sound.

No mad running or poking around,

Just wait till the enemy is out of town.

COVID-19 DISASTER AT THE DORMITORIES 

CRISIS IN SINGAPORE

Contrary to what most people think, I do NOT blame the Govt for the viral disaster in the dormitories. Why?

(1) The dormitories are the way they are for many years and there had not been any significant efforts clamouring for change over the years. So the outcry over their living conditions is a mere reaction to the widespread infections there, not a sudden realisation that we have not treated the foreign workers right.

(2) Let’s imagine for a while, if you can, that we are very lucky and there had been NO cases at the dormitories, do you think anyone will be talking about them?

(3) The dormitories are the way they are because it is the result of an economic imperative to provide housing for masses of foreign workers at the lowest cost. It was not meant to be pandemic-proof.

(4) We had gone through SARS (2003) and H1N1 (2009) without involvement of the dormitories.  They are a problem this time because we are all surprised by the very high transmissibility of SARS-CoV-2. The way it became out of control was not predictable.

(5) It is unfair to blame the Govt for not doing anything earlier because there is not much they can do once the outbreak starts. It’s already too late. Even now, those cramped conditions still persist. The sheer number (323,000) of dormitory workers precludes any quick remedial action to change the space dynamics of the lodgings. 

(6) Under very difficult conditions, the Govt has done admirably by quickly isolating, gazetting and locking down the dormitories and close down most parts of the construction industry. The fact that we have modest and falling local transmission while the cases explode at the dormitories attest to their hard work and success in preventing spillage of the fire into the local community. This is what we should be thankful for.

(7) Though the Government don’t say so, they are probably in the midst of shifting out large swathes of workers into alternative lodgings to rectify the overcrowding and prevent further increases of case numbers.

(8) You can’t help but marvel at how our tiny Singapore is still able to cope with the 11,178 cases and daily increases of more than 1,000, with rational management and harnessing of limited resources.

(9) So, instead of admonishing and condemning our own Govt who are already facing sharp criticism from observers, I think we should give our full support and give them confidence to overcome this unforeseen crisis.

(10) In short, if it had been any other epidemic or any other virus, the dormitories in its present state will not attract any due attention from anyone. It is unfortunate that this SARS-Cov-2 happens to spread so easily.

Covid-19 Viraemia Iron Displacement Theory 

A proposed pathophysiological explanation

https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173/1

The basis of my theory of the pathophysiology of SARS-CoV-2 is based on and an extension of the above paper by Liu wenzhong and Li hualan who used conserved domain analysis, homology modeling, and molecular docking to postulate that in an infection, the ORF8 and surface glycoprotein of the SARS-CoV-2 virus bind to the porphyrin of the heme of our hemoglobin while its orf1ab, ORF10 and ORF3a proteins act to unbind iron from the heme and release it into the plasma as ferrous or ferric ions.

So my theory goes like this:

(1) 80% of the infected are mild and they recover because their immune system is strong enough to clear the virus from the mucous membranes of the nasopharynx, bronchial tree and perhaps the superficial parts of the lung parenchyma where it replicates. If this superficial infection is not cleared in good time, it will enter the bloodstream causing a sudden deterioration after about 1 week of infection.

(2) Unlike classic SARS and the MERS viruses, SARS-CoV-2 has the tendency to enter bloodstream through perhaps the alveoli in hosts with weak immune system or whose immune system is weakened by prolonged infection. Significant viraemia occurs in about 20% of hosts.

(3) Once in the bloodstream, in the mechanisms as described by Liu wenzhong and Li hualan above, the virus binds to hemoglobin, thereby unbinding iron from heme, releasing ferrous or ferric ions into the plasma which is carried in the bloodstream as non-transferrin bound iron (NTBI) to all parts of the body. 

(4) Iron in this form is highly toxic because it is a catalyst for the formation of reactive oxygen species which causes oxidative damage and inflammation in many organs contributing to organ damage including the lungs itself producing the typical uniform ground-glass appearance on chest CT scan. This ground-glass appearance may not be a sign of pneumonia as asymptomatic patients also show this radiological sign (a sign of undetected viraemia).

(5) Meanwhile, the displacement of Fe from the hemoglobin causes prolonged and profound hypoxemia that may not be correctable by O2 and/or ventilation.

(6) The combination of oxidative and/or hypoxic damage of multiple organs leads to their failure and eventually to death.

If this theory is correct, there are several implications:

(1) Early signs like high fever and chills, severe headache, body aches and joint pains, fatigue, diarrhoea, skin rashes and neurological symptoms are signs of early viraemia and should be recognised/treated as such.

(2) Once infected, the key to preventing severe illness and and death is early supportive care and early administration of anti-viral treatment (if available) to all patients to prevent viraemia.

(3) If no such reliable or safe anti-viral is available, high dose anti-oxidants may be administered prophylactically and maintained throughout the illness.

(4) This may explain why Chloroquine/Hydroxychloroquine seems to have some therapeutic benefit because it may inhibit the binding of ORF8 and surface glycoproteins to the porphyrins and prevent the action of orf1ab, ORF3a and ORF10 proteins in unbinding Fe from the heme. Big efforts should be expended to ensure its safety if used.

(5) Since the problem in severe/ critical cases is not lack of oxygenation or ventilation, but an inability of pre-existing haemoglobin to carry oxygen and an abundance of toxic iron in the plasma, a blood transfusion/exchange transfusion may the appropriate treatment once viraemia is significant.

6) Patients with Type A blood type have more severe symptoms than those of Type O maybe because the binding of iron to their heme is probably genetically weaker, and therefore iron is more easily displaced from it.

I may be horribly wrong, but this theory explains many of the peculiar things about Covid-19. I welcome all criticisms.

                                                           

WHAT IS THERE FOR US TO BELIEVE IN?

When we couldn’t stop it at the gate,

We knew it was already too late.

The sky grew darker day by day

As time for containment melted away.

While it started slow, it soon surged

Till pain, despair and death converged.

Though we heeded the early sign,

It’s a new plague of a different kind.

We stood around wringing our hands,

Lost in the ruins of our broken plans.

We stopped work and skipped class,

But the enemy is still within us.

What is there for us to believe in,

But human spirit and our will to win?

With drumbeats of battle in every heart,

We fight for our lives two metres apart.

                                                         dl       

                “My mask protects you; 

                your mask protects me.” 

Flatten the curve

Flatten the curve, flatten the curve,

Don’t let the virus invade our turf.

Now, let us just hold our nerve

For what rewards do we deserve?

Flatten the curve, flatten the curve,

It’s in the fourteen days that you serve.

As you trace left, right, below and above,

In this grand act of universal love!

Dedicated to my friend Peter

Covid-19 is now way up,

So, business is down.

Doctors are all fed up.

People can only frown.

But things will get better

And we won’t be stuck

As long as we have Peter

To give us good luck!

Democratic Primaries

First, they deliver Bernie Sanders.
But, he’s been returned to senders.
So now they want Joe Biden,
Not knowing he’ll bite them!

THE RAT VS THE BAT

https://www.google.com.sg/amp/s/www.sciencealert.com/snakes-are-the-likely-source-of-china-s-deadly-coronavirus-here-s-why/amp

Will the world in the year of the Rat

Suffer again from the virus of the bat?

Brought no more by camel or civet cat,  

Now it’s snakes throwing us on the mat!