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* Thursday thoughts return after a short absence. In his FaceBook page Dr. Qais Ghanem continues to express his thoughts about important social issues which are vital to the public.
“I was one of the participants at a debate on the role of Arabs in Canada in a virtual TV program which in the last minutes was dedicated to an important and sensitive topic. The debate was on how Arab migrants (Muslims, Christians and secular) should guide their children to preserve our Arabic language, traditions, rituals, return etc.
And I say after spending 50 years in Canada, I predicted that, despite parents' guidance, these children will choose to be Canadians to the far, without fear or embarrassment, because they will realize that they have to fully integrate In Canadian society, with all its advantages and disadvantages, so that they can have all the citizenship, including street language, i.e. English and French, even at the expense of mother tongue, including participation in Local games, local sports, music here, local dress, and local customs among young people such as the Arab young man with a white Canadian young woman of Irish descent, for example, so the Arab girl will face the same option and will accompany a young man of origin Scottish, Italian or Abyssinian!
It was my opinion during the evening's interview that Arab youth, especially Christian and Arabs, will find it is in his favor and it is in the good of his future to live the reality of the community so he will challenge the family from time to time, if he can't, he will rebel against his parents and he will make his way out of the family. But I believe that such a rebellion will be less among girls, at least at first, and in the first generation but it will undoubtedly go away in the second generation i.e. in our grandchildren. I am asking the new Arab generation born in Canada to contribute to the exchange of views on this page. The future is their future, either we the elderly will not present or dismiss the future of Canadian youth of Arab origin.”
* Aden College alumnus Farooq Murshed sent us a presentation about the surge of Coronavirus in Aden. The presentation was delivered by Dr. S. Siva who worked in the Occupational Health at Aden  Refinery Company Hospital.
Dr. Siva offered his tips to health workers who are in the front line of treating Corona patients.
"The most important defense that is going to protect you from the Coronavirus is still common sense with some soap, and mask !"
If you have a habit of touching the face with your unsaniticized hand, eating snacks with a lowered mask, repositioning the mask with pinching on the front side, then probably you are already infected.
1. First, know your enemy. Simple two rules - the virus spreads through air at a very close distance or through contact. All your moves will be based on this information with eternal vigilance with improvement in each moment.
2. You need to relax; understand the mortality figures you see in the newspapers.
The virus runs an asymptomatic course probably in the majority.(1)
Imagine the virus is sprayed on 100 peoples’ nose. 60 of them will never develop any symptoms and out of the rest 40, 20 may develop severe symptoms requiring hospital admission and out of these last 20, one person dies. The hospital will report the ‘case fatality rate’ as 1/20=5%. Note that only 20 reached the hospital to get the testing done. The actual risk of death is 1/100 which is called the ‘infection fatality rate’. Its very difficult to find the figure, as no body knows the asymptomatic infection rates. For the current Corona epidemic it is estimated(2) by mathematicians to be around 0.5%. So don’t worry, 99.5% of the time, odds are in favor.
3. Being a health care worker (HCW), are you at higher risk of complications compared to public ? Probably no. All the complications depends on your age, and not the number of the viruses that goes inside. No significantly different viral loads in nasal swabs were observed between symptomatic and asymptomatic patients with SARS Cov-2 infection.(3)
4. During a cough or sneeze, salivary spray contain different types of particles. The larger respiratory ‘droplets’, are >5-10 μm, and travel only 3-6 feet due to their weight. The transmission through this is called ‘droplet transmission’. Very small ‘droplet nuclei’, <5μm in diameter, can remain suspended in the air for long periods of time and travel greater than 1 m- Airborne transmission.
In an analysis by WHO and China of 75,465 COVID-19 cases in China, airborne transmission was not reported.(4)
Now let the fear factor disappear, and you can think clearly and calmly about the defense.
5. N95 vs Surgical mask vs cloth masks- choose the right shield at right time.
Hence use a surgical mask when you are sitting in OPD or taking rounds, and N95 (to filter small droplet nuclei) only when you are doing or near to an aerosol generating procedure. Wear a cloth mask when you are in community, as the purpose is to prevent transmission from you. Use resources intelligently and effectively. You may require it for the big and long battle, just in case.
6. Don’t underestimate the surgical mask. It was found good even when incubating.(5)
7. Refrain yourself from lowering mask for making phone calls, while talking to your colleague, or inside your OPD. Refrain yourself from touching the front side. Refrain yourself from saying that the mask is suffocating (it is and will be; you need to compromise).
8. When you remove the mask for taking a tea, remove the lower tie first. Don't touch the front side. Keep the mask inside your table drawer on a tissue paper, front side down carefully. Practice hand hygiene after handling it- after removing or putting it back.
9. Make sure that, all around you are using the mask properly. If a friend lowers his mask for chatting with you (with a sigh of relief on his face) he is ready to shoot 3000 droplets in 5 minutes into air.
10. Don’t go near your colleagues wearing mask with nose exposed, over the head, under the chin. Talk to them from a distance.
11. Don’t go to canteen or mess room; bring food and eat inside your room or order food. Ask your nurse or assistant to eat inside your room too. Don’t talk during chewing.
12. Practice hand hygiene after each patient. Ask your colleague to monitor you. Watch your colleagues and give feedback; they shouldn't get infected so that you also won’t.
13. Inside the OPD, install a good exhaust fan. Maintain good air circulation inside the room. Keep the temperature of AC to the highest tolerable; droplet wont travel towards sky. They will settle on floor soon. Install an exhaust inside the toilet also.
14. Corona can enter through eyes. Always wear a mask and an eye visor/face shield right from the parking lot of hospital (personal recommendation). Do not remove it even while talking to your friend or nurse.
15. Avoid lift and take the stairs. If you are using lift, stay facing the walls keeping social distancing.
16. Always insist all the patients to wear a mask.
17. Tell the front desk to advise to wear mask to who ever calls for an appointment.
18. Start a separate fever clinic at some corner of your hospital. A doctor with full PPE can see patients here. Arrange a separate pharmacy for them.
19. Don't go near the patients every time, unless absolutely needed. Turn their head to opposite side while auscultating, taking blood pressure, giving injections or drawing blood.
20. Limit the number of nurse visit to patients room by clubbing all the activities together- like checking vitals and delivering food and medicine.
21. Minimize transport of the patient inside the hospital, check the PPE of the accompanied persons.
22. All other staff stay outside the operation room, while the patient is being intubated and extubated during anesthesia.
23. Try to settle thing over phone as far as possible. Use Telemedicine. Don’t offer excuse; learn it.
24. Maintain social distancing inside the hospital like the same poles of a magnet. The droplets travel at very close distance only.
25. At home, don't go near your parents. Ask them to wear mask. If you happen to cross their path, keep your breath in slow inspiration.”
References
1. Day M. Covid-19: identifying and isolating asymptomatic people helped eliminate virus in Italian village. BMJ. 2020 Mar 23;368:m1165.
2. Russell TW, Hellewell J, Jarvis CI, van-Zandvoort K, Abbott S, Ratnayake R, et al. Estimating the infection and case fatality ratio for COVID-19 using age-adjusted data from the outbreak on the Diamond Princess cruise ship. medRxiv. 2020 Mar 9;2020.03.05.20031773.
3. DC, MT, FR, VD, MA, PP, et al.
The early phase of the COVID-19
outbreak in Lombardy, Italy. 2020 Mar 20;
4. Aylward, Bruce (WHO); Liang W (PRC). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). WHO-China Jt Mission Coronavirus Dis 2019. 2020;2019 (February):16–24.
5. Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, et al. COVID-19 and the Risk to Health Care Workers: A Case Report. Ann Intern Med. 2020 Mar 16.
* Dr. Wadah Shihab Ghanem the son of Dr. Shihab Ghanem wrote a paper concerning the environment on the website of Transform for environment and  sustainility professionals in the United Arab Emirates.
The UAE has gone through a stunning transformation. In just two decades, the country, particularly Dubai, has become a tourism hotspot, famous for its numerous skyscrapers and architectural marvels rising up from the desert.
Oil was largely responsible for this boom in economic development and financial prosperity, with the Emirates National Oil Company (ENOC) instrumental in the country’s upturn in fortunes. However, with concerns around climate change and sustainability at an all-time high, the fossil fuel industry is under immense pressure to adapt to a low-carbon world.
Dr Waddah Ghanem Al Hashmi, senior director of sustainability, operational and business excellence at ENOC, is on the frontline of this transition, and explains here how he fights for that change.
Read more here.
* Dr. Mohamed Ali albar commented on the book of Henry Kamen which he authored recently by the title "The Invention of Spain".
"Beloved brother Ashraf Girgrah, Thank you very much for sending the email about the book of historian Henry Kamen on the history of Spain, in particular about the so-called Catalan and Spanish nationalism.
The prejudices that appeared in Europe in the name of the different nationalities that took shape since the beginning of the thirteenth and fourteenth centuries AD and appeared strongly in the sixteenth and seventeenth centuries AD and the subsequent national wars and competition between European nationalities for colonizing the non-European world. Spain succeeded in colonizing Central America South America, while Britain succeeded in colonizing North America (Canada and the United States later), then it became a British empire that does not set the sun by colonizing India, Australia, and New Zealand.
The rivaled European countries of France, the Netherlands and Germany in varying degrees as Tsarist Russia tried to colonize large areas in Turkestan and other Islamic countries until it reached the borders of Iran and Afghanistan.
As for the Spanish Bourbons, their influence extended to Italy and to the Vatican itself.
It also established the huge state of Austria and became an important empire in the history of Europe in the sixteenth century and later.
All European countries set up to confront the danger of the Ottoman Empire, which extended to the walls of Vienna itself (the capital of Austria).
And all of Europe, including Tsarist Russia, defied the Ottoman Empire until it was ended at the beginning of the twentieth century by the rebellious Kamal Ataturk movement against the Ottoman Empire with the full support of European countries, particularly the British.
Ataturk was a Jew of the dunma from which one of the Jewish rebels who claimed to be the expected Messiah and some Jews followed him, but the Ottoman Empire arrested him and the Sanhedrin (the Jewish judiciary) sentenced him to death, but he was able to annul this ruling by declaring his Islam and his whole group.
The group continued to work secretly against Islam and against the Ottoman Empire and conspired with European countries to end the Ottoman Empire and lead the way to the leadership of the modern Turkish state led by Kamal Ataturk.
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