Ram Arora Podcasts Library

A whopping 39 percent GPs are thinking of leaving the profession in the coming 5 years , if something isn't done soon, we may be 22000 GPs short which could very well be a fatal blow to the NHS . The current GP workforce crisis seems to be a product of increasing workload , reduced staffing and increasing complexity of cases due to an ageing population. The need for action by the government is now and the consequences of inaction are going to be dire for the NHS. It is time for some bold and radical action by the government .....(and it's not just about the pay).

Group A strep prevalence has more than doubled as compared to previous years. However there is also an increase in Influenza infections. The current scientific opinion behind the rise in invasive Group a Strep infections (iGAS) is that the high prevalence of viruses causing coinfection is essentially lowering people's Immunity and thus leading to a more severe episode of group A strep infection. All the more a case for everyone to have their flu vaccine and there is a larger than usual cohort of people eligible. Listen to learn more.

Here's the complete lowdown on whats happening across British general practice at the moment around group A Streptococcus and scarlet fever. And how everyone getting their flu vaccine would help immensely.

Although the covid cases remain stable, there has been a 40 percent increase in influenza related admissions largely driven by children under 5 yrs of age. It is an opportune time for all that are eligible to take their winter vaccines. Covid booster uptake is currently sat in the region of 70% as vaccine fatigue has set in. The NHS faces a perfect storm this winter with covid lurking in the background, an exponential increase in influenza cases along with staff vacancy related issues. There has also been an increase in adult norovirus cases and we have all read about the Streptococcal A infections. Thus there are a multitude of pressures facing the NHS. We can do our bit by ensuring that we are uptodate with our covid and winter vaccines.

As a part of the 'living with Covid Plan' published in mid February 2022, today from 1st April the government is scrapping free Covid tests (with the exception of patient-facing NHS and care staff and Clinically extremely vulnerable patients). The UK Government mentions high levels of population immunity secondary to a successful vaccination programme and effective antiviral treatments as a reason for the scrapping in addition to the prohibitive cost to the taxpayer. However, both Care bodies and Doctor's organizations have criticized this move. Blood Cancer UK has mentioned that "Protection from Covid should be a right, not a privilege". BMA has said that providing free tests only to clinically vulnerable people once they develop symptoms, and not providing any free tests to their friends and family, was “completely illogical, as the priority should be protecting them from infection in the first place.” Patients Association, said that charging patients for lateral flow tests “creates a barrier” that would exacerbate health inequalities for those who may not be able to afford them. “Charging for tests will contribute to covid-19's continuing spread.” Here are my thoughts on this subject, telecast live today in the morning show with Ben Prater about this thorny issue on BBC Radio Wiltshire.

During the Covid 19 crisis in the last 12 months the NHS was faced with the gargantuan task of providing 100 million vaccinations. The NHS in this war like effort was crucially support by an enormous number of volunteers. It was their selfless and determined efforts, that made this task possible and their contribution may have saved atleast 120,000 lives in the UK . Volunteering has scientifically proven benefits for a person's mental health . Ancient scriptures mention selfless service as a pathway to contentment . We discuss both the crucial role of volunteering in the NHS and it's benefits in detail in this interview.

Omicron is very much here in the UK . It is more infectious than the delta and other known previous variants . It was the 24th of November when we heard of this variant and now we find ourselves in an unenviable position this winter again of a race between the virus and the vaccine . Data shows that a third "booster" dose provides as much protection against the Omicron variant as two doses did with the original virus . But scientific modeling suggests that due to exponential rate of spread 2.5k infections per day could translate to 100k infections per day in a matter of a month . So we find ourselves back again in a race against time . Hopefully the data is proven wrong here but we may as well assume the worst and do our best today than to repent later a few months later from now . Given the virus is spreading more rapidly and it's an airborne virus, social distancing , wearing mask in enclosed poorly ventilated spaces and working from home where possible becomes all the more relevant. Time again to think of a multifaceted approach around fighting this virus .

My discussion with James Thomas today evening about Covid Booster delivery in Swindon & Wiltshire. Steam vaccination centre is designated a centre of excellence nationally for its levels of efficiency and performance in terms of service delivery of covid vaccines since the start of the pandemic . This centre is run solely under the primary care leadership collaborating with the government bodies. This should provide listeners with confidence that the centre is capable of rising to the challenge of vaccinating all above the age of 18 with a booster by the end of January.

Covid toes are the most common dermatological manifestation of Covid 19. They are seen in predominantly white caucasian ethnicity and patients are usually young and thin. They also seem to occur in the later half of clinical disease. Most cases are asymptomatic and self resolve within 15-30 days. What's quite fascinating about them is that majority of them test negative on Covid 19 RT PCR and Antigen tests. Listen to the podcast to discover what might be causing that and what might be the clinical significance and future application of this finding. Listening time : Approx 20mins

Chilblains like lesions (CLL) are the most common cutaneous manifestation of covid 19. These tend to usually occur in the Caucasian paediatric population / young adults. Quite baffling is the associated fact that the majority of these patients test PCR negative to covid. These young patients tend to produce a very early onset copious amount of interferon 1 IgA subtype which essentially defeats the virus very early on, thus preventing detectable levels of antibodies to be built up subsequently. Immunofixation finds these IFN - 1 deposits in covid toes. These are thus now thought to be due to a combination of endothelial dysfunction and immune mediated response "activation loop" following covid 19 infection.

The NHS enters the winter phase surrounded by the "perfect storm" with an unprecedented backlog of cases, the threats from Flu and RSV which may act synergistically with Covid 19 infection and cause infections of greater severity, an expected increase in wintertime hospitalisations from non-communicable diseases (eg Asthma, COPD, IHD), staff and equipment shortages and what is an already overburdened service seeing an unexpectedly high demand on its resources. The fact that > 75% of our population is double vaccinated is indeed a feat of science. Vaccine confidence nationally seems to be high. The risk however is "Vaccine Over-confidence", where all other preventative measures such as social distancing, wearing masks, well-ventilated workspaces, meeting people outdoor wherever possible is put aside for the sense of security that being vaccinated brings. Indeed there is data from Israel that antibody levels wean after 6 months or so. This may increase susceptibility to infection but the vaccines still continue to provide protection from developing a serious infection. There is also data that records a three-fold reduction in transmission in those vaccinated. 99.5% of the mortality in the last 6 months occurred in those who weren't double vaccinated at the time of infection. There is the risk of a "triple lethal combination" of Flu, RSV and Covid 19 working together to overwhelm an already outstretched health service. The Covid 19 causing virus may also experience a natural "selection pressure" when it will need to compete with the other winter prevalent respiratory viruses and this may also force a new mutation. What could the general public do to minimise their risks? The unidimensional approach of either focusing on any one intervention such as testing, lockdowns or mass vaccinations are bound to fail and a multidimensional approach will need to be adapted to keep ourselves safe and to safeguard the NHS. This means utilising any and all of the above options should they be deemed necessary along with basic pillars of managing respiratory infections such as face masks, social distancing, hand hygiene, good ventilation etc. This will safeguard us from both Covid 19 and Flu/ RSV infections common in the winter season. Additionally, it is important for those who are vulnerable to self assess their risk and exercise greater caution. By exercising the above precautions the population could safeguard themselves and others dear to them. It is a fallacy to assume that the governments would need to walk a tight rope between securing the economy vs managing the covid pandemic as the data from other countries already shows that for the economies to be truly secured, the covid 19 threat needs to be managed first and foremost. The Government was given guidance around managing Covid 19 in Mid July with respect to the planning for the 2nd Winter with Covid-19. We start the winter with a higher number of cases as compared to the same time last year. We hope that this guidance is heeded this time around and a more proactive approach is adopted by the policymakers. Our personal freedoms are important but when they interfere with the safety of others then it becomes a separate matter altogether and leadership needs to step in. Getting this timing right for such a government intervention will always be a difficult act to pull off for anyone in power. References 1. https://blogs.bmj.com/bmj/2021/09/09/john-middleton-is-the-nhs-prepared-for-the-coming-winter/ 2. https://www.bmj.com/content/374/bmj.n2270 3. https://acmedsci.ac.uk/file-download/4747802

BBC Wiltshire today : My thoughts on lockdown easement and the concepts of personal responsibility, personalised risk and exercising caution. Short interview lasting 3 minutes. The important thing to note here is that there is only a modest protection provided by the vaccine in acquiring an infection post vaccination but the overall protection is bolstered by subsequent significant reduction in transmission rate, development of serious illness and reducing deaths. The common sense approach would be to use other measures such as masks and personalised risk assessment of individual circumstances whilst cautiously coming out of a lockdown so as to not get infected at the first place and thus keeping the prevalence rate of the virus low. Greater spread of the virus could again lead to development of new variants some of which could be resistant / less susceptible to the vaccines. Indeed a tricky balancing act for the government.

Long covid seems to affect 14 % of those with Covid according to a recent study published in the BMJ in May 2021 . The UK by June 2021 had 4.6 million confirmed cases of covid. The reality is that British general practice hasn't seen as many cases of long covid as were expected. Patients self managing and most patients having a self resolving 12 week illness may be the causes here. But we know that covid affects the vulnerable communities disproportionately and these communities are less likely to reach out and seek help. In terms of symptoms, more than 50 sequelae post covid are defined and seem to affect almost every system of the human body. Self help resources mentioned are 1. https://www.yourcovidrecovery.nhs.uk/ 2. https://www.post-covid.org.uk/ 3. https://www.rcot.co.uk/how-manage-post-viral-fatigue-after-covid-19-0

This is my interview recorded with BBC Wiltshire on 19/5/21 at 7am GMT. Here I discuss with Ben Prater about what is known about the Indian variant and what weapons we have in our arsenal to combat it. The mental health impact of the pandemic is also explored. The clip concludes with my thoughts on how to reach the difficult to reach populations so that we have an impenetrable vaccine coverage across the UK population.

Punjabi Detox is a channel geared towards the subsection of the Asian population struggling with alcohol addiction in the United Kingdom. In this episode we look at the new data from the Office of national statistics which has recorded a 19.6% increase in alcohol specific mortality. This data is available here : https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/quarterlyalcoholspecificdeathsinenglandandwales/2001to2019registrationsandquarter1jantomartoquarter4octtodec2020provisionalregistrations

The 2nd covid wave in India is the worst covid 2nd wave for any county with 2.2 million cases in the last week alone. Here I discuss the multifactorial causes behind it.