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Social distancing is slowing not only Covid-19, but other diseases too

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Social distancing is slowing not only Covid-19, but other diseases too

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Health and Wellness

Gita Ramjee, a Leading AIDS Researcher, Dies at 63

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This obituary is part of a series about people who have died in the coronavirus pandemic.

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After earning a Ph.D. at the University of Natal in Durban, South Africa, in 1994 while raising two young children, Gita Ramjee was exhausted.

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Her thesis had been on kidney diseases in children — she had worked in a pediatrics ward at a local hospital — but she took a job on a small research project in a different field, since it promised a less frantic pace. It was a life-changing choice.

The research involved whether a vaginal microbicide was useful against AIDS, which was rampant in South Africa. The research put her in contact with sex workers, who told chilling stories of economic hardship, high-risk behavior and men who were indifferent to using protection.

“It opened my eyes,” Dr. Ramjee told The Guardian in 2007.

“That’s when I knew I wanted to be involved in the prevention of H.I.V. infection in women,” she added.

Dr. Ramjee became a leading researcher on the AIDS epidemic. On Tuesday another epidemic claimed her: She died of Covid-19, the disease caused by the coronavirus, at a Durban hospital. She had become ill shortly after returning from a visit to her sons in London, local news accounts said. She was 63.

Dr. Ramjee was chief scientific officer at the Aurum Institute in Johannesburg, which battles AIDS and tuberculosis and announced her death on its website. She had previously been director of the H.I.V. prevention unit at the South African Medical Research Council.

Those jobs put her at the forefront of the effort to contain AIDS, especially in eastern and southern Africa, which has long had the highest rate of H.I.V. infection in the world.

Gita Parekh was born on April 8, 1956, in Kampala, Uganda, to Dhirajlal and Nirmala Parekh. After Idi Amin, the Ugandan dictator, forced Asians to leave that country, Dr. Ramjee finished high school in India, where her family was from, and then earned a bachelor’s degree at the University of Sunderland in England. There she met her future husband, Pravin Ramjee, a South African of Indian descent, and they settled in South Africa in the early 1980s.

After joining the research council in 1996 she rose through the ranks, administering studies and drug trials, with a particular focus on helping women avoid AIDS.

“Gita was fundamental and inextricably linked to the endeavors to find solutions to prevent H.I.V. in women,” Glenda Gray, president and chief executive of the council, said in a statement on the organization’s website.

Especially in places like southern Africa, that effort remains urgent. Winnie Byanyima, executive director of UNAIDS, a global organization working on the issue, called Dr. Ramjee’s death “a huge loss at a time when the world needs her most.”

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In addition to her husband, Dr. Ramjee is survived by two sons, Shaniel and Rushil Ramjee; a brother, Atul Parekh; and three sisters, Rita Kalan, Asmita Parashar and Reshma Parekh.

Dr. Ramjee recognized early on that the response to AIDS could not be simplistic, and that the key was finding ways to give women control in cultures and communities that did not always encourage that. Policymakers, she knew, needed to understand that the ABC approach, as it was often called — “abstinence,” “be faithful” and “condoms” — was not enough, a point she made at the annual International AIDS Conference in 2006.

“I would like to believe H.I.V. prevention will be more than ABC,” she told the conference. The room burst into applause.

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Health and Wellness

Aerobic exercise at home: a routine with exercises that you can do in your living room

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Maintain a healthy lifestyle during the days of confinement is essential: to do this we will have to take care of our food, our rest and add more physical exercise to our routineto compensate for the lack of activity to which we are subjected.

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For those who want to do a cardio routine simple in the living room of the house and barely any materialhere you have a complete workout that you can carry out in a few minutes.

Training design

Because aerobic exercise requires efforts of low intensity and long duration, we will combine them with bodyweight exercises that maintain an adequate level of intensity to the time we will use rope to extend the demand aerobic at the time.

The exercises that we will perform are the following:

Distribute the training for blocks of work in which there will be a exercise protagonist in every one of themwith the exception jumps to the sag that will be present in each of the blocks.

First block

In this first block, the exercise protagonist will be the burpees, which we will combine with jumping rope. This structure will be maintained in the following two blocks.

First round

  • Burpees for 30 seconds
  • Rest for 15 seconds
  • Jumping rope for a minute
  • Rest for 15 seconds
  • Burpees for 30 seconds
  • Rest for 15 seconds
  • Jumping rope for a minute

Second round

  • Burpees for 20 seconds
  • Rest for 15 seconds
  • Jumping rope during a minute and a half
  • Rest for 15 seconds
  • Burpees for 20 seconds
  • Rest for 15 seconds
  • Jumping rope during a minute and a half

The breaks between rounds should be between 30 and 60 seconds.

Second block

The breaks between blocks can be up to a minute, no more. In this block, the main exercise are jump squats, keeping the same structure as that in the previous block.

First round

  • Jump squats for 30 seconds
  • Rest for 15 seconds
  • Jumping rope for a minute
  • Rest for 15 seconds
  • Jump squats for 30 seconds
  • Rest for 15 seconds
  • Jumping rope for a minute

Second round

  • Jump squats for 20 seconds
  • Rest for 15 seconds
  • Jumping rope during a minute and a half
  • Rest for 15 seconds
  • Jump squats for 20 seconds
  • Rest for 15 seconds
  • Jumping rope during a minute and a half

As before, the breaks between rounds should be between 30 and 60 seconds.

The third block

To finish, the jumping jacks will be the protagonists. There are numerous variants of this exercise so choose any of them, the important thing is to keep the effort at the time.

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First round

  • Jumping jacks for 30 seconds
  • Rest for 15 seconds
  • Jumping rope for a minute
  • Rest for 15 seconds
  • Jumping jacks for 30 seconds
  • Rest for 15 seconds
  • Jumping rope for a minute

Second round

  • Jumping jacks for 20 seconds
  • Rest for 15 seconds
  • Jumping rope during a minute and a half
  • Rest for 15 seconds
  • Jumping jacks for 20 seconds
  • Rest for 15 seconds
  • Jumping rope during a minute and a half

Images | iStock

Videos | StreamFITtv

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Health and Wellness

With Virus Surge, Dermatologists and Orthopedists Are Drafted for the E.R.

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One of the largest hospital networks in New York has given its doctors an ultimatum: either help deal with the coronavirus crush, or stay home without pay.

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At other hospitals, too, all hands are being called to deck. Neurosurgeons and cardiologists, orthopedic, dermatology and plastic surgery residents — all have been pulled into emergency rooms and intensive care wards. Receptionists who normally deal with billing are also being told they will be reassigned, to emergency rooms to help screen Covid-19 patients.

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This is what the redeployment scramble looks like as hospitals, girding for a surge of coronavirus cases in the next two weeks, face an acute shortage of doctors and nurses trained in intensive care settings.

From cream-of-the-crop surgical specialists to nurses, physician assistants and administrative staff, health care workers who have not done a critical care shift in many years are having to retool themselves overnight — and not always voluntarily. There is pressure from co-workers, guilt about not helping, and fear about the risks to themselves and their families.

“I feel like I’d be pretty clueless in these units actually,” said an orthopedic physician assistant at a Long Island hospital who usually works on elective surgeries. The assistant, who said she had “zero critical care experience,” declined to be identified because she feared she would be fired for speaking publicly.

She and other physician assistants had received an email from their supervisor, who reminded them that another hospital in the area had made the assignments mandatory. “I did not want to go that route but everyone needs to pitch in,” the email said.

Northwell Health, the network that has told its medical staff to redeploy, has 2,900 Covid-19 patients in its 17 hospitals, which include Long Island Jewish Medical Center, Lenox Hill in Manhattan and Staten Island University.

“If you’re employed by us, it is expected you can be reassigned to an area of need,” David Battinelli, Northwell’s chief medical officer, said in an interview. Those who do not agree will be furloughed without pay, he said.

Dr. Battinelli said clinical staff would be reassigned based on their skills and comfort level. All elective surgeries have been canceled across the Northwell network, and only 20 percent of its patients, he estimated, were coming in for non-coronavirus emergencies like heart attacks, strokes and injuries.

Conference rooms, lobbies and some cafeterias were being converted to intensive care units; the network plans to expand its bed capacity by 60 percent.

“Obviously that puts pressure on trying to find staff to support those patients,” said Terry Lynam, a Northwell spokesman. “That’s the biggest concern — to try to get additional staffing.”

On Thursday, Mayor Bill de Blasio called for a national draft of doctors and medical workers to be sent to places where the virus has hit hardest, starting with New York. Some hospital systems had already been pleading for help from outside their networks. On Wednesday, NewYork-Presbyterian Hospital put out a call on Twitter for doctors and nurses, as it tries to expand intensive care units and emergency rooms in its hospitals.

Late last week came an urgent call from Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine in Manhattan, whose faculty work in several New York City hospitals.

“We are running out of ICU trained doctors,” he wrote in bold type in an email to a national medical association, asking for intensive care physicians from other states and promising to cover the cost of travel, housing and meals.

Even before the United States had confirmed cases of the coronavirus, it was facing a growing physician shortage because of its increasing and aging population. A recent study projected a shortfall of between 46,900 and 121,900 physicians by 2032.

Last month, the medical association of critical care physicians warned that Covid-19 would strain the country’s roughly 29,000 intensive-care-trained physicians. “Having an adequate supply of beds and equipment is not enough,” the association, the Society of Critical Care Medicine, wrote in a blog post, adding that “the intensivist deficit will be strongly felt.”

In New York State, the exponential growth of virus patients, with nearly 15,000 hospitalized, has stretched medical workers to their limits, both numerically and psychologically.

Stefan Flores, an emergency room doctor at NewYork-Presbyterian/Columbia University Medical Center, had an orthopedic resident by his side recently, and said specialist doctors were helping monitor patient vitals and doing bedside rounds. On a 12-hour shift, he has had to do as many as six intubations.

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“I do think we need more doctors,” Dr. Flores said. “It’s unsafe to deal with the acuity and volume we are dealing with. I’ve been on shifts where I’ve never felt so overwhelmed.”

The anxiety among the redeployed is pouring out on WhatsApp and in text messages. “Now doing ED shifts for the first time in 17 years,” one doctor said on a WhatsApp group chat, referring to the emergency department. “Our ICUs are full and vents are pretty much all being used.”

A neurosurgeon at a Manhattan hospital learned last weekend that he would have to work in an I.C.U. alongside an intensive care doctor. He said he worried that at some point, intensive care doctors would fall sick or be overwhelmed by patients and that non-I.C.U. doctors would be managing ventilated patients.

On his first shift, the neurosurgeon, who declined to be identified for fear of retribution, was assigned a N-95 mask and told to use it indefinitely. Several times an hour, code blue alerts were called out on the hospital loudspeaker, indicating a medical emergency. “Everybody is dug in for the long haul,” he said.

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