Home as clinical setting for asymptomatic mild Covid-19 positive patients: What you should know
BY Dr Ruvaiz Haniffa
Head, Dept of Family Medicine Faculty of Medicine
University of Colombo And Past President Sri Lanka Medical Association
Most people with COVID-19 develop mild or uncomplicated illness that can be managed at the primary care level, and the demand for primary care services will escalate during periods of increased transmission. Health policymakers at the national and subnational level will need to take appropriate action to support the role of primary care in the response, such as managing mild COVID-19 cases or recovery of hospitalized cases, identifying strategies to increase surge capacity, managing and maintaining stocks of personal protective equipment (PPE) and other essential supplies, and maintaining of essential services, while ensuring timely adaptation to address the needs of vulnerable groups.
With the rapidly increasing incidence of COVID-19 in Sri Lanka and the health systems possible inability to provide in hospital care for PCR positive COVID-19 patients; the HOME as a setting for clinical care provision for asymptomatic mild COVID -19 patients may indeed become possible or even necessary. In this context pre-emptive planning for provision of home-based care for carefully clinically triaged and selected patients becomes important.
As per the WHO, COVID-19 is classified in to 3 clinical entities- mild, moderate, and severe (Fig.1). People classified as having mild COIVID-19 with no symptoms should be able to stay at home, if adequately isolated from others. This also implies that if you are symptomatic even with mild COVID-19 you will require hospital admission.
Care pathway for COVID-19 Positive Patients in Sri Lanka
Decision to care for COVID-19 patients at home.
This decision cannot and should not be made by the patient or the family. This decision must be made after clinical triage by a healthcare team which must include a family physician and social worker who is aware of the patient’s physical home infrastructure in addition to the past and current health status of the patient.
Home care should be considered for an adult or child with confirmed COIVD-19 when in patient care is unviable or unsafe (e.g. when heath care service capacity is insufficient). It must be understood that home care increases the risk of transmitting the virus to others at home. However, isolation of people at home and using the home as a clinical setting to provide care to carefully selected patients can make an important contribution to breaking the chain of transmission of the virus.
Home care (provided requirements are fulfilled) should ideally be considered for individuals under the age of 60yrs, do not smoke, are not obese and have no other diseases such as cardiovascular diseases, diabetes mellitus, chronic lung disease, cancer, chronic kidney disease or immune suppressed.
The decision as to isolate and care for an infected person at home depends on the following 3 factors.
1. Clinical evaluation of the COVID-19 patient
2. Evaluation of the home setting (Please see Box 1).
In the Sri Lankan context of considering home as clinical setting for COVID-19 home care the following in addition to Box 1 should also be considered.
2.1. Adequate floor space area with minimum two individual rooms, adequate natural ventilation and two toilets
2.2. Home should preferably have access to running water.
2.3. The infected patient/family should be equipped with communication facilities to contact healthcare providers routinely and in an emergency.
3. Ability to monitor the clinical evolution of the person at home.
What to monitor in a COVID-19 positive patient receiving home care
The patient and care giver must be adviced about the signs and symptoms of complications or how to recognize deterioration in their health status that requires medical attention.
The most important parameters to monitor in the home setting are fever, difficulty in breathing, fast or shallow breathing, blue lips or face, chest pain or pressure, confusion (which was not present earlier), inability to wake up, inability interact when awake and inability to drink or keep liquids down
. For infants in addition to these, grunting and inability to breast feed also must be considered. (Please note this list is not an exhaustive list and if you have any doubt, please contact healthcare team immediately)
Home pulse oximetry is a safe, non-invasive way to assess oxygen saturation in the blood and can support the early identification of low oxygen levels in patients with initially mild or moderate COVID-19 or when patient does not appear short of breath but their oxygen levels are lower than expected (Silent Hypoxia).Home pulse oximetry can identify individuals in need of medical evaluation, oxygen therapy or hospitalization, even before they show clinical signs of worsening signs or symptoms.
This author is of the view that if home care for mild asymptomatic COVID-19 positive patient is recommended the minimum requirement should also include the possession or access to a finger pulse oximeter.
What should be done to prevent other people in the house from becoming sick if a person with COVID-19 is being cared for at home?
It is highly recommend that the patient, caregiver/s are given a simple and short orientation programme to use the provided equipment and to create awareness on the ‘red-flag’ signs to look out for and contact the primary health care provider for further instructions.
There are several precautions that can prevent the spread of COVID-19 to other people in the house:
The ill person should stay in a separate room. If this is not possible, then keep at least a 1-metre distance from them. The sick person and anyone else in the same room should wear a medical mask.
Provide good ventilation in the room of the ill person and shared spaces, and open windows if possible and safe to do so.
The ill person should wear a medical mask as much as possible, in particular when not alone in the room and when at least a 1-metre distance from others cannot be maintained. Limit the patient’s movement around the house and minimize shared spaces. Ensure shared spaces (e.g. kitchen, bathroom) are well ventilated.
Visitors should not be allowed in the home.
Limit the number of caregivers to one person with no underlying conditions, if possible.
Caregivers and household members should wear a medical mask while in the same room with an ill person, not touch their mask or face during use, discard the mask after leaving the room, and wash their hands afterward.
The ill person should have dedicated dishes, cups, eating utensils, towels and bed linens. They should be washed with soap and water, and not shared.
Frequently touched surfaces by the ill person should be cleaned and disinfected at least daily.
Everyone in the household should wash their hands with soap and water regularly, especially:
– after coughing or sneezing
– before during and after you prepare food
– before eating
– after using the toilet
– before and after caring for the ill person
– when hands are visibly dirty
A cough or sneeze should be covered with a flexed elbow or a disposable tissue that is discarded immediately after use.
The waste from the ill person should be packed in strong closed bags before disposal.
The household (patient and care giver/s) should be encouraged to have steady supply of masks (essential, 3 ply surgical mask would do), face shield (optional), disposable or washable overalls (optional), 70% alcohol hand sanitizer (optional in the presence of clean running water and soap)
How long should people with COVID-19 stay at home and in isolation?
People with COVID-19 who are cared for at home should stay in isolation until they are no longer able to transmit the virus to others:
Those with symptoms should stay isolated for a minimum of 10 days after the first day they developed symptoms, plus another 3 days after the end of symptoms – when they are without fever and without respiratory symptoms.
People without symptoms should stay isolated for a minimum of 10 days after testing positive.
Please check with you Family Physician/PHI for updated release from home isolation guidelines as they subject to update.
Primary care is an essential foundation for the global response to COVID-19. Primary care plays a significant role in gatekeeping and clinical responses: identifying and triaging possible COVID-19 cases, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, and reducing the demand for hospital services. The role of primary care has been increasingly important as cities imposed strict control measures including non-pharmaceutical interventions and as larger hospitals closed their outpatient departments during periods of increased transmission.
There also is an increasing role of home care for COVID-19 cases within communities supported by a strong primary care system, which strengthens the trust between health-care workers and communities. A response built around primary care has also been a more cost-effective measure.
The SARS-CoV-2 Virus is doing its job. Are we as individuals, families and communities doing our job to prevent the spread of the virus? None of us will be safe until all of us are safe.
The government/health authorities by allowing the home care of mild asymptomatic COVID-19 patients are taking us the people of Sri Lanka into their confidence and giving us responsibility to actually be part of the clinical care process of COVID-19 management in Sri Lanka. Let us not disappoint the government/health authorities by misusing, manipulating, and abusing the trust they have placed in us. Let us show them that we the people of Sri Lanka if given responsibility will deliver on in it in the context of home care for COVID-19 patients.
Home care for patients with suspected or confirmed COVID-19 and management of their contacts. Interim guidance 12th August 2020. Updated 2nd March 2021.
Role of primary care in the COVID-19 response. Interim guidance. Revised and republished as of April 9th, 2021 (Originally published 26th March 2020).
Petitions, Trevor Moy and the story of a Vidyodaya graduate driven to JVP
by Capt. FRAB Musafer, 4th Rgt. SLA (Retd.)
(Continued from last week)
On my return I was ordered to take over Tissamaharama from Lt Wijesuriya and Lt Gemunu Wijeratne who were based in the comfort of the Tissa Rest House. During this time we were issued with a rationed quota of duty free local cigarettes , Kandos chocolates and beer, (not to be consumed but as a take home item) for the first and perhaps only time.
Operations were fairly routine based on informants. The daily mail received consisted of anonymous petitions blatantly incriminating persons with no involvement whatsoever in the insurgency. In addition I was called upon to look into land disputes, recovery of money lent, fraud, infidelity and a host of other problems people encountered and had no avenues of seeking redress in a hurry. Much to the dismay of my sergeant I tended to ignore most of them. One day the sergeant walked in with a wry smile on his face and asked me ” What are you going to do about this Sir?”.
The petition was addressed to the Army Captain threatening me with castration, to put it better language. It was signed bearing the name of a local strong man. We found this person and asked him to name the likely letter writer. He named a few, whom we picked up and took them to the camp. Having lined them all in front of a light machine gun on the banks of the Tissa Wewa, an ultimatum was given that the entire lot would be shot unless the person who sent the petition stepped forward.
After a few minutes one of them meekly owned up and said he did it, stating the named person was committing an injustice to them by extorting money and preventing them from selling and despatching their produce out of Tissa at favourable prices. The rest did not hesitate to support his claims. We warned the person concerned and asked him to refrain from carrying on this intimidation and threatened him that we would arrest him and send him to prison with the thrasthwadayas (insurgents),
Whilst at Tissa a suspected insurgent surrendered at the camp. He said that he was surrendering because the police had threatened to burn his father’s home and that it was the last thing he wanted. His father, he said, had mortgaged his properties and had got into debt to spend for his tertiary education at the Vidyodaya university. He had successfully graduated but could not find any employment to pay back or help his father sort out the debts incurred. In desperation he had applied for a labourers position at the salt pans and the interviewer had told him that he could not give him the job since he was more qualified than the interviewer.
He pleaded with him but to no avail. Looking back he said that he should have not presented himself as a graduate but again was not sure he would have got the job anyway as he had no political connections. The reason he was sympathetic to the cause was because there was no other avenues to pursue and there was no hope for the future. He asked me a question “What would you have done Sir in my circumstances”? I was in no position to answer him, he was more qualified than me albeit with an arts degree. To me it summed up the causes, an over supply of arts graduates, no jobs to placate them and undue hardships and frustrations of the youth in the rural areas. There were no job opportunities available in this region. It was an area that was totally neglected. He was a no hoper and driven to desperation.
Based at Tissa I was asked to escort three bus loads of suspected insurgents from the Tangalle prison to the Vidyodaya University which was converted as a temporary prison. Driving into Colombo at dusk I found a city under siege, with roads closed and barricaded and well lit with searchlights directed skywards. There were plenty of troops deployed and a dusk to dawn curfew imposed and military checkpoints established at key points. I was stopped at the Kirullapona bridge by no less a person than Brigadier Jayaweera and Major Ranjith Wanigasundera, a fellow regimental officer. Brig Jayaweera was shocked that my convoy of three jeeps was the only security for the three busloads of detainees. It never occurred to me that Colombo itself was also under threat. I proceeded to Vidyodaya University and handed over the detainees to the prison officials.
Next day I had to collect a staff car for Col Nugawela and also pick up Mr Trevor Moy, Managing Director of George Stuarts, who was Colonel Nugawela’s boss. On our way we had tea at the NOH at Galle and Mrs Brohier the manageress of the Hotel made some remarks about some North Korean involvement. The Sunday papers used to have a full page supplement on Kim ul Sung the north Korean leader. There had been rumours that there were some North Korean ships waiting offshore loaded with weapons to support the insurgents.
The North Koreans were expelled from Sri Lanka. The extent of their involvement was never made public and there was no evidence that arms had been supplied to the insurgents. Had they received arms the outcome may have been prolonged and different.
On arriving at Tissa around noon with Mr Trevor Moy I found that Lt Jayakumar a volunteer officer and a planter by profession who was holding the fort at Tissa was not in camp. Colonel Nugawela was looking for him and no one had a clue to his whereabouts. He had taken a jeep with an army driver and driven off and was missing from the previous night. However, much to our relief he turned up shortly looking tired and worried. He was not keen to go back to Hambantota to face the Coordinating officer and tell him of his ordeal at the Yala national park.
What was a drive through the park turned out to be a night to remember. His jeep had a flat tyre at the furthest end of the park and had no spare. He had no torch , no food or water and no idea where he was and made the decision to walk along the beach till light permitted. Continued his walk in the morning and eventually with the help of the park authorities repaired the flat tyre and made it back to the camp.
I was told another volunteer officer Lt Nilaweera nearly killed himself when his sterling sub machine gun went off as he attempted to free the weapon which had got stuck in the front seat of his jeep. the bullet whizzing past his ear.
The following day Colonel Nugawela dropped in at Tissa and enquired if Mr Moy has had breakfast, I replied “Yes, Sir.” The next question was what did he have to which I replied “toast, fried eggs and sauteed liver with onions in butter.” He blew a fuse and repeated “liver liver?” (this was the menu suggested by the rest house manager) but before I could say anything else Mr Moy butted in and said “Derrick I quite enjoyed it, in fact I haven’t eaten it for such a long time.” His intervention and diplomacy saved the day for me. I was totally unaware that liver which was expensive and deemed nutritious to the locals was offal and a cheap food to most westerners.
During the five hour drive from Colombo I was engaged in a long conversation which covered many topics and I found that Mr Moy was very knowledgable of Ceylon and a very amiable individual. I was told he loved Ceylon so much that his last wish was that his ashes be scattered over the tea estates he managed during his planting days.
Whilst at Tissa I was asked to relieve my batchmate from Pakistan. Lt Gamini Angamanna, who was stationed at Wellawaya to enable him to participate in a counter insurgency operation in Moneragala being undertaken by the Gemunu watch troops under Col Bull Weeratunga. Gamini was shocked to see me drive in my trusted army jeep windscreen down and no canopy, the truck was no better. He admonished me for not adequately protecting myself.
His vehicles were boarded with sawn satin timber logs giving some protection from shot gun fire. The troops in this area had been subjected to ambushes and had been under fire, whereas I had never been subjected to any enemy fire and was oblivious to any danger. Looking back I think I was foolhardy and naïve but extremely lucky to have operated in an area where the insurgency had lost its momentum or for that matter not got off the ground.. On the other hand I wonder if the presence of the Army since mid March had a detrimental effect on the planning process of the JVP in the Hambantota area.
Sri Lankan hospitality despite being poor.
On information provided to coordinating headquarters I was ordered to take a platoon of volunteer troops in search of a suspected insurgent hideout. With no maps and only the informant as our guide we took off at the crack of dawn. It was not long after we realized we were lost. The platoon sergeant suspected we were being led into a trap and suggested that we should bump off the informant. I took no notice of his request. We eventually located the hideout that had been abandoned leaving traces of food and packaging materials. which may have been used to protect the weapons if any.
Heading back to camp we lost our way once more. The volunteer soldiers were not the fittest and were finding it hard to keep up in this elephant infested jungle. We had no clue where we were headed for but continued to trudge in one direction till we hit a cart track that eventually led to a hut. We asked the occupant how we could go to Kataragama to which he replied he did not know but said he could show the way to Wellawaya. As we were parched and exhausted we asked him for some water. He produced two Kala Gediyas of water and said that he will get us some more as there were around twenty of us. Before he left he cut a few papaws and served us apologizing that this was all he had. He said it wont be long but he took over an hour to get back. Something which I will remember all my life is the hospitality of this one man who virtually had nothing and was struggling to make a living by planting chillies in an elephant infested jungle. He was surviving on the government subsidized free rice ration and a miris sambol. The true extent of poverty is never identified by our ruling elite.
Hospitality is synonymous with Sri Lanka but in my mind nothing epitomizes this unselfish act of a very poor man with such a big heart thinking nothing about himself. Sri Lanka is blessed with such good men.
Having rested and with him as the guide we set off towards Wellawaya, crossed the Menik Ganga where we saw crocodiles lazing on the banks. Soon after we found a typical tractor track which took us back to civilization. We came across a house where a wedding was being celebrated with the bridal car parked nearby. With the consent of the wedding party we commandeered the Morris station wagon to enable a few of us to get back to camp and bring transport back to pick up the rest. We did not forget our good Samaritan to whom we sent some of our dry rations and also cash to reimburse the cost of petrol. The soldiers were not only grateful but had realized the hardships he was enduring to make a living.
Rural poverty- bartering
There was also another incident in 1972 during mopping up operations in the jungles off Kantalai that stays vivid in my memory of the hardships and poverty which people in the villages endure. Here whilst on a patrol we came across a little girl no more than six to seven years walking alone on a track in an elephant infested area. She was on an errand to get some panadols for her mother in exchange for the little bit of rice she carried in a paper bag. The rice incidentally was the free or subsidized issue given by the government, which establishments like the World Bank and IMF wanted stopped. This was the first time we had encountered bartering and was moved by the plight of this little girl.
This has served me as a reminder that there are so many needy people out there struggling to survive in these areas and wonder what their plight is today. A myth prevails that villagers can make do to survive and will not starve. They are simple and hard working but neglected and a forgotten lot by the city dwellers. The politicians who are entrusted to improve their lot and provided with gas guzzling SUV’s sadly fail to do so. They, the rural poor too have their dreams and aspirations to improve their lot.
Sri Lanka’s was no comparison to the poverty in India. On an overnight train journey to Assam to follow a course in counter insurgency and jungle warfare I witnessed a pathetic sight. A little boy with oversize shorts and his fly open picked up the paper wrapping of the sandwiches we had eaten and licked it just for the taste of it. What a cruel world!
Nalin’s days at the races, back to London to qualify in teaching physiotherapy
(Excerpted from Memories that Linger: My journey through the world of disability by Padmani Mendis)
Nalin, from his days at university, had an interest in horse racing. In his bachelor days he would, with a group also of bachelors go often to the race meets at Colombo and Nuwara Eliya. Times spent with them I could see had been great fun. The fellowship they enjoyed together continued even after our marriage.
It was a Saturday morning ritual that they would meet at Sidath (Sri Nandalochana’s) bachelor home at Asoka gardens. This was strictly a “men only” thing. Talked not only of the horse meets that were to be held that day and the horses that would run but also of the condition of the favourites and the chances of the trainers and jockeys. From this I could understand that discussions invariably extended into the political happenings of the week and the state of the economy. Besides Sidath and Nalin, participating in the first part of the discussion there was Archie and his brother Dougie; to join the second part were Bandu, Nada and Willa.
To the surprise of my family and friends, I always encouraged Nalin to pursue his interest in the horses. His approach was a scientific one. He studied each horse that stood a chance from breeding to form. To do this he would obtain somehow the latest issue of “Time Form”. If not the latest, an old one would do. With the advent of internet and the web, the study of horse racing became much easier and even more scientific.
Nalin’s interest was not gambling – the bets he placed were small. It was the enjoyment of the sport. His enjoyment came from picking the winner, not from how much he won at the races. I still encourage him to pursue this interest. I believe it keeps his mind stimulated. I can see the difference in his level of activity generally when the UK Racing Season is on and when it is taking its winter break. Last week he told me with glee that Royal Ascot was on. We talked of the time we had been there and saw the Queen. He said that he had picked a 66 to 1 winner. Because of covid and lockdown he could not place a bet. But that did not seem to bother him.
In Search of Fulfilling Work
My work atmosphere at the DPM Special was very pleasant and there was a mix of physios here. A few seniors with many juniors from different batches. We all got on very well and had much fun playing jokes on each other. But however pleasant it was, if I was to have an impact as a physiotherapist in Ceylon, I thought it would be more fulfilling to teach physio to those potentially new recruits. When a vacancy occurred for a tutor at the school of physiotherapy, I applied for it.
The Health Department required that an appointment as Tutor Physiotherapist should have the Diploma in Teaching Physiotherapy or Dip.TP awarded by the Charted Society of Physiotherapy or CSP, UK. To do that diploma course, one needed to be a Member of the CSP which I was. So when I was accepted at the school it was on the understanding that I would have to go abroad sometime and obtain the diploma.
This coincided well with the news Nalin received from his employer, the Department of Inland Revenue, that he was to be sent to Queen Elizabeth House or QEH, Oxford for one year in October 1974. I secured a place at Guys Hospital, London as a Student Teacher for the course starting in September of that year. This course led to the Award of a Diploma in the Teaching of Physiotherapy. I then obtained unpaid leave from my employer, the Department of Health and was ready to proceed with the next stage of my career.
Preparing to Take Off on Another Journey
Nalin’s travel and the course at QEH were all paid for by the British Council. He would even receive a monthly stipend which was more than adequate for his stay in the UK. I would receive a monthly allowance as a student teacher at Guys and that would enable me to live comfortably in London. But I had to meet the cost of my travel to London. Once I got to London the situation would ease. I had a little money in an account in a London Bank saved from my time as a student. This would see me through to my first pay packet from Guys.
The cheapest route to London was on the Soviet airline Aeroflot. This required a flight change at Moscow airport but that did not matter. I booked my flight on Aeroflot. But we had no money to pay for the ticket. So what were we to do? Without so much as batting an eyelid, we sold our car. With the dire state of our country’s economy and the severe restriction of imports, prices of motor vehicles had sky rocketed. So we were able to raise four or five times the amount that Nalin had paid for the car. But this was not enough.
With the closed economy had come also a good second-hand market for household items. Abans Corner Shop had opened for the sale of second-hand goods. Auction rooms had opened their doors for the same purpose. We approached these sources and got the best price we could for all our electric utility items. These could always be replaced. I am a little sad now that we also gave to the Auction Rooms our Queen-Anne Style Drawing Room Suite from Apothecaries and some Corning-ware dishes, a wedding present from London friends. Both items I could never replace. A little bit of regret just there.
Having paid for my ticket, the next matter of concern was that I would have to travel via Moscow with not a penny in my hand. This I was certainly not going to do, I was not going to take that risk. Exporting foreign exchange was not allowed, and anyone caught taking foreign currency out of the country was subject to arrest.
But this currency was available freely on the black market. I bought a five pound sterling note. I had in my possession a hand mirror with a screw handle. The handle was hollow. All I had to do was to unscrew the handle, roll up the note and push it inside. Once re-screwed, no one could find my five pound note. I was now ready to take off on my journey.
But I was unusually nervous. I am generally one of those people who took things in my stride. This situation was different. I had heard a story recently of someone being arrested at the check-in counter for having foreign dollars on his person. Another had been taken off the flight just before it took off for a similar reason. And I had my five-pound note. For safety I was carrying this in my hand luggage and clutched this firmly to my side. Finally, we were on board and the plane left the runway. Relief – my five pound note and I were safe.
I opened my hand luggage to retrieve it. I gasped. The mirror was shattered. The Romans believed a broken mirror brought the person who owned it seven years bad luck, and Sri Lankans followed the Romans in this belief. I was not superstitious, so when I was off the plane the incident was quite forgotten. It came to mind later only to be related to amuse my friends. The next seven years, and indeed all the years thereafter brought me more good luck than I could have hoped for.
An Unexpected Experience of Moscow
Travelling to London on the Aeroflot flight were two close friends, Mervyn and Therese whom I have written about earlier. Aeroflot was a popular airline because of its low cost. The flight was always full. This in spite of the bad reputation it carried of flight delays and missed connections to London. We heard that this delay happened almost every week. And it happened also to us. Which meant we would have to wait almost another 24 hours for the next connection. Our fellow passengers were sleeping anywhere and everywhere, uncomfortable though the hard benches were.
I was fortunate that I was travelling with Mervyn and Therese. Because the Ambassador for Sri Lanka in the Soviet Union at the time was a good friend of theirs. As soon as the time was reasonable enough to make a call in the morning, Mervyn did so and told him that we were at the airport. The ambassador sent an employee to meet us.
As instructed, the accommodating employee took the three of us on a sightseeing tour around Moscow. Then for a late meal at the residence of the ambassador before he brought us back to the airport to wait for our connection. The accommodating employee told us that invariably the weekly flight would carry a passenger or two who was known to the ambassador. So this was a task he had to carry out regularly. He quite liked doing this and meeting different people from home.
So this unexpected, but really expected, stopover in Moscow was quite an adventure. We had the opportunity of travelling on Moscow’s underground. The stations were incredibly beautiful in their architectural design and decor. Attention to detail with much colourful drawings and artwork. This was quite in contrast to London’s dull and boring underground stations. Everywhere was very clean and the trains were modern. Seemed to run on time unlike the airline.
The opportunity we had of spending all the time we wanted in the Kremlin was sheer good fortune. Just a fascinating colourful place with so many domes and picturesque rooftops of the very many centuries-old cathedrals and palaces contained within. The intricacy of their design was to be appreciated when one was up close. Our accommodating employee had by now learnt something of Russia’s history and shared this with us. The Kremlin dated back from the 13th century.
Another place that is yet clear in my memory is the museum illustrating the Battle of Borodino. It is a large circular hall depicting the battle on its walls as a panorama. We learned that the Battle of Borodino is where, in 1812, the Russians are said to have defeated Napoleon. Napoleon had entered Moscow, but the Russians forced him back and kept their city. Why I remember it so clearly is because the panorama looked very real. One could almost feel the battle actually being fought. This is a popular tourist site. And then a walk across Red Square was a must do. We did so much walking that day. We were young then. And hungry for adventure.
I was leaving Nalin for the first time in our married life. Almost all through our engagement we had lived apart so one may say this was not new to us. It was still difficult to foresee how lonely it would actually turn out to be. Until he joined me in London we used the postal service and the blue air letter forms were useful once again. Previously they were an indispensable tool enabling us to get to know each other. This time it was to maintain the companionship we had nurtured during our first five years of marriage. The postal service had improved and our contact with each other reached us much more quickly than it had previously.
Looking further, although we were both in the UK, we would not be together. His work was in Oxford and mine in London. Let’s leave that for later – we will jump that fence when we came to it. For now, we would next meet in the UK.
A Vote for Trump is a Vote for Biden – Governor Sununu
by Vijaya Chandrasoma
The candidates for the Republican nomination for the Presidency in 2024 seem to be shaping up, falling into two categories: those who walk a thin line by announcing their candidature for the 2024 Republican nomination, which Trump has already announced, without a word of criticism about the Fuhrer; and those who butt heads with Trump like any serious contender for the presidency.
Surely, those candidates who are still cautiously neutral about their attitude towards Trump, will soon summon up the courage to aggressively compete with him if they are serious about winning the presidency. Like the efforts made by former Vice President Pence, at a CNN moderated Town Hall meeting in Iowa last Wednesday, when he mildly criticized the seditious actions of his former boss on January 6, 2021.
Republican Chris Sununu, Governor of West Hampshire, falls into neither category. Sununu (48) was considering a run for the 2024 presidency, until he gave up the ghost a few days ago. Pity, he was one of those Republicans who would have been considered a “normal”, traditional candidate of the Party of Lincoln. In an interview with CNN, he said he chose not to be a candidate as he wanted to have a more “candid, a little more unleashed voice….particularly in moving the party away from Trump”.
He does not tread the white supremacist, authoritarian path that Trump has forged for today’s Republican Party. He is more in line with the Party’s pre-Trump agenda, prudent fiscal policies, small government and the rule of law, and ambivalence about abortion and LGBTQ rights. In other words, a breath of fresh air in the GOP in an atmosphere of the rancid, noisome pollution Trump has infused into the Party since 2016.
A frequent Trump critic, Sununu says his decision was based on the fact that “a crowded primary field would hand the nomination to Trump, who earns just 35% of the (Republican) vote”. He argued “if Republicans nominate Trump, they are just helping President Joe Biden, adding: “A vote for Trump is a vote for Biden”. Republicans will lose again. Just as we did in 2018, 2020 and 2022″.
Another candidate who does not fall into either of the categories described below is former New Jersey Governor Chris Christie. Christie was a big fan of Trump, in fact was Trump’s Transition Manager after he won the presidency in 2016. He was one of the sycophants who was constantly with Trump till his loss of the 2020 election, the Big Lie and the January 6, 2021 insurrection, which he found impossible to countenance. Treason has now become the only red line many Republicans refuse to cross.
Christie is aware that he has little chance of being elected president, and his main motive is to stop Trump. When questioned about Trump’s base, Christie said, “There’s no such thing as Trump voters. He doesn’t own them. I voted for him twice. Am I a Trump voter? Hell, no, man”.
The cautiously pro-Trump category has already had one casualty in Florida Governor Ron DeSantis, currently Trump’s closest pursuer in the polls, though lagging by over 20 points. DeSantis made all the movements of a presidential candidate before making an official announcement on May 24. However, even before DeSantis officially announced his candidature, Trump had recognized him as potentially his main rival. The gloves now seem to be off, on both sides. The electoral war is reaching a crescendo, trading personal insults taking pride of place over declarations of their future political agenda.
DeSantis’ policies are even more Christian, radical right, white supremacist than those of Trump. He is homophobic to the point of paranoia, and has imposed anti-LGBTQ laws, initiating an argument with the state’s biggest employer, Disney. He has already banned books which, in his opinion, are offensive, with subject matter of genocide, slavery, Jim Crow, racism, the actual history of the United States. In his white supremacist opinion, such history will confuse and induce guilt in the minds of white, Christian children. These books, many classics, on history and the Critical Race Theory have already been banned in Florida, Virginia and many other red states.
Tragically, the latest masterpiece to be banned by DeSantis in Florida is the inaugural poem of supremely gifted, 25-year-old African American poet, Amanda Gorman, “The Hill We Climb”. A most optimistic poem about “a nation that isn’t broken but simply unfinished”. The sentiment which may have offended the DeSantis clan enough to ban the poem is: “We’ve seen a force that would shatter our nation, rather than share it, Would destroy our country if it meant delaying democracy, And this effort very nearly succeeded”.
DeSantis recognizes the Party he represents as this potential destroyer. This is the truth he wants to hide from our children. Of course, he is well aware that ignoring history will only encourage it to be repeated. Which is the dream of the radical red, Trumpian party he represents – a return to a Christian, white supremacist America.
Former Governor of South Carolina and US Ambassador to the United Nations, Nikki Haley was the first, after Trump, to announce her candidacy for 2024 in February. At a recent Town Hall meeting in Iowa, moderated by CNN’s Jake Tapper, she gave a professionally faultless performance, treading the traditional conservative line on questions about the economy, domestic and foreign issues . At 51 years of age, she represents a new generation of Republicans. Most importantly, she maintained that January 6, 2021 was “a terrible day”, and made a forceful case for US involvement in the Ukraine war. Opinions which would have earned her the wrath of her mentor, Donald Trump, reference to whose name was conspicuous in its absence throughout the meeting.
Former Vice President Mike Pence officially announced his candidacy last Wednesday at the aforementioned Town Hall meeting in Iowa. Pence was the most vanilla, sycophantic Trump devotee during his term as Vice President. His job during the entirety of his four years as VP was to be seen on TV, at rallies and meetings, looking adoringly at Trump. He did not have one opinion that was different from that of Trump. He was a paradoxically homophobic, ultra white Christian, reputedly never allowed by his wife, aka Mother, to be at an occasion where other ladies were present, unless Mother herself was also in attendance.
I despise him for continuing to show fawning deference towards the man who tried to have him and his family assassinated on January 6. But he will always have my respect and admiration for the one act of patriotic bravery he displayed when he carried out his constitutional duty on that fateful day. He defied Trump’s instructions to break his constitutional oath in certifying the Electoral College votes, which formally anointed Joe Biden as the 46th President of the United States.
He did this in spite of threats to his family and himself by Trump supporters, who were chanting HANG MIKE PENCE, having constructed a gallows at the Capitol grounds for this purpose. He did this in spite of these bloodthirsty killers being 40 feet away from him when he and his family were being rushed to a safe area in the Capitol. He did this when the Secret Service, acting on instructions of the traitor Trump, tried to whisk him away to Alaska, to stop him certifying the presidency. When he was led to the car, he uttered the six words which probably saved our democracy and will go down in history: “I’m not getting into that car”. He was determined to carry out his constitutional duty of certifying the Presidency that very night, as he knew that any delay would have given Trump a second chance to commit another coup, perhaps successfully, next time around.
Mike Pence is the unsung hero of January 6, 2021. No one can take that away from him. Never mind what he was or what he has, and will, become.Tim Scott (58), African American Senator from South Carolina, is a steadfast conservative, who more often than not voted with Trump. However, The Guardian describes his vision for America “as the complete opposite of Donald Trump”.
He thinks that, in spite of Trump’s commanding lead in the polls, “his sunny vision” for America’s future can sway a significant number of Republicans who are ready for new leadership in the party. He is also a single straight man, a devout Christian who is against extra-marital sex, therefore presumably a virgin. As such, he may not be eligible for the presidency, as sexual activity and questionable morals have been, with a few notable exceptions, a sine qua non for many an occupant of the Oval Office.
There are others, entrepreneur of East Indian origin, Vivek Ramasamy (37); former two-term Arkansas Governor, Asa Hutchinson (72); Virginia Governor, Glenn Youngkin (55) and North Dakota Governor, Doug Bergum (66), who may add a little spice into the Republican primary debates, without having a semblance of a chance of success.
President Biden’s stellar performance in the first two years of his administration, and his recent successful bi-partisan resolution of the debt ceiling crisis, only proved that leadership should be judged by performance alone. President Biden’s age has proved to be of little consequence during his first term, which is proving to be one of the most successful in history. In any event, if necessity arises for whatever reason, the Democrats have a Vice President in Kamala Harris in the wings, and a depth of leaders eminently capable of seamlessly continuing with President Biden’s progressive policies,
Most Republicans, but for the extreme Christian white supremacists, have had it with Trump’s vulgarity, lies and ongoing indictments. Also, Trump’s continuing legal woes, recently exacerbated by his former Chief of Staff, Mark Meadows having agreed to testify, on grounds of immunity, at the Special Counsel’s investigation of the Documents scandal, may have finally sealed his fate. He will be running his campaign with indictments on multiple felonies hanging over his head.
If the Republicans present Trump, or any other radical-red, MAGA alternative as their 2024 candidate, the Party will lose to 82-year-old Biden by a margin which even Trump would not dare dispute. Even if the Republicans choose a moderate conservative, I believe Trump’s violent efforts to overturn a legally constituted election and destroy our democracy may have scuttled the Party’s political aspirations to the presidency and Congress for the next few elections.
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