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Ask The Doctor l What hospitals need to do to prepare for 3rd wave

Ask The Doctor l What hospitals need to do to prepare for 3rd wave

Ask The Doctor l Lessons we need to learn from the 2nd Covid-19 wave

Ask The Doctor l Lessons we need to learn from the 2nd Covid-19 wave

On this week's episode of Ask The Doctor, Dr Naresh&nbsp;Trehan of&nbsp;Medanta&nbsp;talks about the lessons we need to learn from the second wave of the Covid-19 pandemic.&nbsp;

As India slowly and steadily emerges out of the deadly 2nd Covid wave, the biggest challenge before the administration now, is vaccination. The govt has said, about 43% of those above 60 years of age have been vaccinated against COVID-19; while 37% of those above 45 years, have recieved at least one jab. India has also seen a 68% decline in daily caseload, as per govt data.
On today's episode of Ask The Doctor, answering all your Covid and vaccination related queries are Dr. Amita Gupta, MD MHS Professor of Infectious Diseases and International Health, Faculty co-Chair of the Johns Hopkins India Institute, Johns Hopkins University; S. Vincent Rajkumar, MD, Editor in Chief, Blood Cancer Journal, Professor of Medicine, Mayo Clinic Rochester, Minnesota, USA; and Dr Aju Mathew, Oncologist and Epidemiologist, based in Kerala.
Watch all the episodes of Ask The Doctor on your editorji app, download at www.editorji.com/download

Ask The Doctor | Top experts answer all your Covid and vaccine-related FAQs

As India slowly and steadily emerges out of the deadly 2nd Covid wave, the biggest challenge before the administration now, is vaccination. The govt has said, about 43% of those above 60 years of age have been vaccinated against COVID-19; while 37% of those above 45 years, have recieved at least one jab. India has also seen a 68% decline in daily caseload, as per govt data.
On today's episode of Ask The Doctor, answering all your Covid and vaccination related queries are Dr. Amita Gupta, MD MHS Professor of Infectious Diseases and International Health, Faculty co-Chair of the Johns Hopkins India Institute, Johns Hopkins University; S. Vincent Rajkumar, MD, Editor in Chief, Blood Cancer Journal, Professor of Medicine, Mayo Clinic Rochester, Minnesota, USA; and Dr Aju Mathew, Oncologist and Epidemiologist, based in Kerala.
Watch all the episodes of Ask The Doctor on your editorji app, download at www.editorji.com/download

On today's episode of Ask the Doctor, Dr. Amita Gupta, MD MHS Professor of Infectious Diseases and International Health, Faculty co-Chair of the Johns Hopkins India Institute, Johns Hopkins University; S. Vincent Rajkumar, MD, Editor in Chief, Blood Cancer Journal, Professor of Medicine, Mayo Clinic Rochester, Minnesota, USA; and Dr Aju Mathew, Oncologist and Epidemiologist, based in Kerala; assure that all vaccines are safe, no matter what brand they are. While mRNA&nbsp;vaccines have shown maximum efficacy, doctors insist people must get vaccinated with whatever is available, because reducing severe disease and deaths is the end goal.


Ask The Doctor | Vaccines save lives, so no two ways about it, say doctors

On today's episode of Ask the Doctor, Dr. Amita Gupta, MD MHS Professor of Infectious Diseases and International Health, Faculty co-Chair of the Johns Hopkins India Institute, Johns Hopkins University; S. Vincent Rajkumar, MD, Editor in Chief, Blood Cancer Journal, Professor of Medicine, Mayo Clinic Rochester, Minnesota, USA; and Dr Aju Mathew, Oncologist and Epidemiologist, based in Kerala; assure that all vaccines are safe, no matter what brand they are. While mRNA&nbsp;vaccines have shown maximum efficacy, doctors insist people must get vaccinated with whatever is available, because reducing severe disease and deaths is the end goal.

On today's episode of Ask the Doctor, Dr. Amita Gupta, MD MHS Professor of Infectious Diseases and International Health, Faculty co-Chair of the Johns Hopkins India Institute, Johns Hopkins University; S. Vincent Rajkumar, MD, Editor in Chief, Blood Cancer Journal, Professor of Medicine, Mayo Clinic Rochester, Minnesota, USA; and Dr Aju Mathew, Oncologist and Epidemiologist, based in Kerala; assure that all vaccines are safe, no matter what brand they are. While mRNA&nbsp;vaccines have shown maximum efficacy, doctors insist people must get vaccinated with whatever is available, because reducing severe disease and deaths is the end goal.

On today's episode of Ask the Doctor, experts say following evidence is key and trying drugs like Ivermectin, Azithromycin and steroids on patients may do more harm than good. Symptomatic care is crucial for Covid patients, they must isolate yourself, drink lots of water, stay at home. Doctors caution against overuse of steroids which has resukted in many patients becoming diabetic and a spurt in black fungus cases.

Ask The Doctor | Follow evidence, don't throw kitchen sink at patients, say doctors

On today's episode of Ask the Doctor, experts say following evidence is key and trying drugs like Ivermectin, Azithromycin and steroids on patients may do more harm than good. Symptomatic care is crucial for Covid patients, they must isolate yourself, drink lots of water, stay at home. Doctors caution against overuse of steroids which has resukted in many patients becoming diabetic and a spurt in black fungus cases.

Why are more and more black fungus cases being reported nationwide? Is it a good idea to mix doses from different vaccines? Has India achieved herd immunity or is there a looming threat of a 3rd Covid wave? 
On today's episode of Ask the Doctor, we take your questions to Dr. Anita Shet, Director of Child Health at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health; Dr. Tapish Sahu, Consultant, Peripheral Vascular &amp; Endovascular Sciences Division, Medanta Hospital; and Gautam Menon, Professor of Physics and Biology at Ashoka University and at the Institute of Mathematical Sciences.
To watch all episodes of Ask The Doctor, download the editorji app now, log on to www.editorji.com/download

Ask The Doctor | Blood clots to vaccines: experts answer all your questions

Why are more and more black fungus cases being reported nationwide? Is it a good idea to mix doses from different vaccines? Has India achieved herd immunity or is there a looming threat of a 3rd Covid wave?
On today's episode of Ask the Doctor, we take your questions to Dr. Anita Shet, Director of Child Health at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health; Dr. Tapish Sahu, Consultant, Peripheral Vascular &amp; Endovascular Sciences Division, Medanta Hospital; and Gautam Menon, Professor of Physics and Biology at Ashoka University and at the Institute of Mathematical Sciences.
To watch all episodes of Ask The Doctor, download the editorji app now, log on to www.editorji.com/download

Ask The Doctor | Black fungus to vaccines: experts answer all your questions

Why are more and more black fungus cases being reported nationwide? Is it a good idea to mix doses from different vaccines? Has India achieved herd immunity or is there a looming threat of a 3rd Covid wave?
On today's episode of Ask the Doctor, we take your questions to Dr. Anita Shet, Director of Child Health at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health; Dr. Tapish Sahu, Consultant, Peripheral Vascular &amp; Endovascular Sciences Division, Medanta Hospital; and Gautam Menon, Professor of Physics and Biology at Ashoka University and at the Institute of Mathematical Sciences.
To watch all episodes of Ask The Doctor, download the editorji app now, log on to www.editorji.com/download

With reports on the formation of blood clots in some recipients of the AstraZeneca&nbsp;Covid&nbsp;vaccine, many in India are hesitant to take the vaccine. On today's episode of Ask The Doctor, Dr Tapish&nbsp;Sahu,&nbsp;Consultant, Peripheral Vascular &amp; Endovascular Sciences Division, Medanta Hospital, explains why its a bad idea to take blood thinners without medical supervision. He says vaccines are life-saving and the benefits&nbsp;outweigh the risk, moreover blood clots are treatable if detected in time.

Ask The Doctor | Don't self-medicate yourself with blood thinners, say doctors

Ask The Doctor | Don't self-medicate with blood thinners, say doctors

With reports on the formation of blood clots in some recipients of the AstraZeneca&nbsp;Covid&nbsp;vaccine, many in India are hesitant to take the vaccine. On today's episode of Ask The Doctor, Dr Tapish&nbsp;Sahu,&nbsp;Consultant, Peripheral Vascular &amp; Endovascular Sciences Division, Medanta Hospital, explains why its a bad idea to take blood thinners without medical supervision. He says vaccines are life-saving and the benefits&nbsp;outweigh the risk, moreover blood clots are treatable if detected in time.

Is the&nbsp;worst over for India when it comes to the second wave or will there be a third wave?&nbsp;&nbsp;On today's episode&nbsp;of Ask The Doctor,&nbsp;Gautam Menon, Professor of Physics and Biology at Ashoka University and at the Institute of Mathematical Sciences, explains why&nbsp;the curve of the pandemic for the second wave is on a gradual decline, but actual data may have to be looked at retrospectively due to under-reporting of cases.
&nbsp;

Ask The Doctor | Covid wave wave in India: is the worst over? Experts say why

Vikram: How would you answer that, yes worst over cases are coming down. Three things are asked about that, number one is there under-reporting? Maybe under-reporting always happen but is there any reason to believe that underreporting is worst now than it was earlier. And are the cases down only because of the lockdown or is there just a natural progression fo all the pandemics that it goes up and then it goes down and that's just the way it is.
 Prof. Gautam Menon: So that part of it is right that all pandemics have a rise to their peak and then they come down. The question is when does this peak occur, how high is this peak and over what time does this peak decay. So regarding the question are we out of this yet, remember that if you look at yesterday's and today's number of cases, they are still registering double of what we had of the peak of the previous wave which was around September of last year. So we have a long way to go, we are still at almost double that peak currently. So we still have to go before we can see what the decline is going to be over the next couple of weeks or maybe months. Is this really only because of the lockdown, certainly the lockdown is important but this burnout effect we spoke about that more and more people being infected and maybe one would say they have some level of protection and let's say for the next three months or six months as far as we know? And that's at least removes them from the pool of people who could contract this disease and that's another reason why the peak comes down. The big question mark, what's happening outside the major cities, what's happening in rural Punjab, rural UP, rural Bihar etc. The centre of gravity of the disease seems to have shifted to down south, so the cases of maximum numbers are in Karnataka, Kerala, Tamil Nadu Andhra Pradesh, Telangana etc. So, we'll have to see what happens now, the questions are really they that there does seem a general decline, there does seem a real decline. What the numbers are actually we'll have to think about, hopefully, they become cheerer in the days to come.
Vikram: Okay, I want to take you up on that little bit. We all have studied for example the 'sutra model'. The sutra model is essentially saying that the look you had the peak and now the cases say the peak was somewhere around the middle of May, now cases are going to fall and they are going to fall so fast that by the 15th-20th of June you are actually going to seeing say 30,000 or maybe 40,000 new cases in all of India per day. It is going to be a really really sharp decline. You could argue about the x-axis, how many or what the numbers are but the shape of the curve so far, at any rate, are falling. So do you argue that is probably what the shape of the curve look like? We can argue about the actual numbers but the shape will see a very sharp decline in the next couple of weeks to come.
 Prof. Gautam Menon: I would put my money on a sort of slower decline. The number has been coming down fairly fast but I think some of that is due to under-counting. We are really not seeing the number of cases, reports in newspapers from large or entire villages in parts of northern India where people have every symptom of Covid but not getting tested therefore they don't record the official numbers. If I could wait a little bit more, so my worry is that the official numbers represent urban India and not represent what is happening in rural India therefore the actual progression of the way the number decays is not as sharp as you might imagine to be.
 Vikram: And one of the reasons for it would be the sutra model and you assuming what the multiple of actual cases to reported cases is constant through the peak. That number is not a firm constant and your actual reporting or under-reporting is three times in the cities and is ten times in rural areas, then you might think that the cases are falling but it is actually slightly flatter. Okay, what is in your mind the under-reporting that we have seen, this has become a very contentious issue, in its cases, it is 10x of what we have reported, 20x of what we have reported or 1x 2x 3x 4x of what we have reported, what would be your best guess?
 Prof. Gautam Menon: So we kind of did a fair study of the first wave, and for there we at least&nbsp;seem to see that there is a fact of 20x between reported and actual cases. The multiple 20 of what is actually reported and the actual number of cases. So you must remember that many of these are asymptomatic, so even if people may have not shown symptoms at all of the viruses. However, in this particular wave, we think the number potentially is somewhere large, somewhere around say 25x-30x but then again that's a guess currently because there are so many uncertainties with the data itself. We don't know if the data is being recorded accurately, what are the large delays in the data being submitted. There are some states that report well and there are some that don't report too well. Because of these uncertainties, it is a bit harder to put an exact number on it. But I think it is certainly above 20x, probably say 25x-30x as it is the second wave of Covid-19.
 Vikram: And deaths?
 Prof. Gautam Menon: So when we did this in the first wave, we found that a multiple of 2.2. So for every death, you have to multiply the number by 2.2 across the whole span of the first wave. However, this time it is really up in the air and I have no clue about the estimates for this at all. We all have scene pictures of bodies, we can't and don't know how to put a number on that. This is going to be the hardest thing to figure out in the weeks and months to come. We can only be able to do it retrospectively by finding all sorts of proxies to determine that number might have been.

Is the&nbsp;worst over for India when it comes to the second wave or will there be a third wave?&nbsp;&nbsp;On today's episode&nbsp;of Ask The Doctor,&nbsp;Gautam Menon, Professor of Physics and Biology at Ashoka University and at the Institute of Mathematical Sciences, explains why&nbsp;the curve of the pandemic for the second wave is on a gradual decline, but actual data may have to be looked at retrospectively due to under-reporting of cases.
&nbsp;

On today's episode of Ask the Doctor, Dr. Anita Shet, Director of Child Health at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, explains why Covid&nbsp;vaccines are safe for children and extensive trials are done before the Pfizer vaccine was approved by the US FDA. She adds, it is crucial to vaccinate children&nbsp;as that can help break the cycle of transmission of newer variants.
&nbsp;

Ask The Doctor | Covid vaccines are safe for children, assures Dr Anita Shet

<ul style="list-style-type: circle;">
<li>Vikram: To what extent do you think it's important for teenagers say 12-18 or 18-25, how important is it for them to actually get vaccinated? vaccines for children....how imp is it for children, teens to get vaccinated?</li>
</ul>
&nbsp;
<ul style="list-style-type: circle;">
<li>Anita Shet: So here is another good question. So the short answer to your question is that it is very important to get your children vaccinated. But that's as I said is just a quick answer. We need to think of all the factors and maybe even go into why the answer is that why is it important for these children to get vaccinated. The main reasons are that of course&nbsp;children need to be protected it is for their own safety and health. In general, we know that children have a milder case of infection compared to older adults, they are definitely less severe but however, the few of them who get the infection...they are severe cases that are reported, typically they are one in thousand or so who get very severe illnesses. In the second wave actually, we see a lot of that, children with underlying conditions like diabetes or asthma then tend to have a really bad infection when they get Covid. The second reason is to stop transmission. In India, the proportion of children under 18 years of age is 41%, so imagine almost half of the entire population is children. So if you want to stop the viral transmission in the country we can't leave out children they have to be considered to a large extent. We need that herd immunity to reach at least&nbsp;what we think is 70-80%, so children have to be included. And the third important reason is that we have to stop viral variants, we have to stop mutations occurring and for that, we need to remove this host population that is carrying this virus, transmitting it, even though they don't fall ill. Recently, we had studied from Israel showing that giving vaccines can keep the variants in check. So, for all these reasons it is important to vaccinate children. Having said that, we have to consider two very important things. One of them is safety which is children are slightly different from adults, their immune systems are different, dosages might be different, so they have to be studied carefully. There can't be any shortcuts, so we need those trials to go on. And the second thing to consider is what you spoke about just now, which is we have to absolutely consider vaccine availability and vaccine access. So right now it is going slow in India for multiple reasons and we really need the high priority populations to be vaccinated. that includes the older adults, people in the frontline and so on. Unless we get those aspects sorted out, we have a good vaccine supply we will not be able to go into children. But that's the entire picture for how to get children vaccinated.</li>
</ul>
&nbsp;
<ul style="list-style-type: circle;">
<li>Vikram: Can vaccines actually stop Covid? Bur specifically on children once again because this is exactly what you are studying, so are the vaccines safe for children? Not all of them are authorised for children, so far. Not all of them have been tested on children, so far. So that makes some parents and another worry is safe, should we be giving vaccines to our children. Or is it just because that's the feasing in which trials have happened and it's just not been tested yet. Is there any reason to believe that the vaccines won't be safe for the children?</li>
</ul>
&nbsp;
<ul style="list-style-type: circle;">
<li>Anita Shet: Right, so that is also a question that has been looked into quite a bit. So far there is no evidence that suggests vaccines may be less safe compared to adults and we have data coming out from the existing trials like the MRNA trials, the ones that are most advanced in trials in children. So, the Pfizer vaccine has been tested in children 12 years and above and the data arrived and it received emergency authorisation and it is being rolled out in the United States. In the UK, the AstraZeneca vaccine is also being tested in children between 6-17 years of age. They started the trial in Feb this year and it has been halted and now they are re-starting the trial. So we should have data from the AstraZeneca vaccine. And the third vaccine is the BharatBiotech vaccine which is the inactivated vaccine, this type of technology has been used for many of the other vaccines that we have in existence. So again, for that technology, we have no reason to believe that it will not be safe for children. So that vaccine, Covaxin is going to start trials in a month or so in India. There is paperwork submitted and they have received some of the approvals from the Indian government to start trials in children to 18 years of age. So we should have some data coming in regarding the safety as well as the indigenousity of the vaccines. </li>
</ul>

On today's episode of Ask the Doctor, Dr. Anita Shet, Director of Child Health at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, explains why Covid&nbsp;vaccines are safe for children and extensive trials are done before the Pfizer vaccine was approved by the US FDA. She adds, it is crucial to vaccinate children&nbsp;as that can help break the cycle of transmission of newer variants.
&nbsp;

Ask The Doctor | In conversation with infectious diseases expert Dr Faheem Younus

On today's episode of Ask The Doctor, we take all your Covid&nbsp;and vaccination related questions to Dr Faheem Younus, Infectious Diseases Expert, University of Maryland. He advocates that India must adopt multiple strategies at various levels to curb the spread of infection, these can be ramping&nbsp;up vaccination numbers as soon as possible, using mass media to educate and inform people about Covid&nbsp;norms and following lockdowns and curbs.&nbsp;On the possibility&nbsp;of another&nbsp;Covid&nbsp;wave, Dr Younus&nbsp;says, if at least 50% Indians are vaccinated, chances of another big wave&nbsp;will be low.
&nbsp;

Ask The Doctor |&nbsp;Dr Faheem Younus: India must ramp up vaccination to control Covid spread

Ask The Doctor | Dr Faheem Younus: India must ramp up vaccination to control Covid spread)

Ask The Doctor | Dr Faheem Younus: India must ramp up vaccination to control Covid spread

Ask The Doctor |&nbsp;Dr Faheem Younus: India must ramp up vaccination to control Covid spread

Ask The Doctor | Dr Faheem Younus explains why people are dying despite being vaccinated

Ask The Doctor | Dr Faheem Younus explains why people are dying despite being vaccinated

Ask The Doctor l How to identify & prevent a cytokine storm in a Covid patient?

Ask The Doctor l How to identify &amp; prevent a cytokine storm in a Covid patient?

Ask The Doctor l What are signs of a cytokine storm in a Covid patient and how they can be pre-empted

Ask The Doctor l Do anti-biotics help in treating Covid-19

Do antibiotics help in treating Covid-19 symptoms?&nbsp;Dr. Mathew Varghese, Orthopaedic Surgeon, Public Health Expert &amp; Former Director, St. Stephens Hospital; explains why antibiotics&nbsp;don't make a difference apart from symptomatic treatment, rather it can lead to depletion of useful gut microbes in a patient.

With the Centre issuing fresh guidelines for Covid-19 vaccination, @ArvinderSoin breaks down the new rules and tells @vikramchandra that the inoculation drive will pick up in August as the two vaccine makers will be able to manufacture over 17 crore doses per month.

Ask The Doctor | Top experts decode government's Covid-19 vaccination guidelines

With the Centre issuing fresh guidelines for Covid-19 vaccination, @ArvinderSoin breaks down the new rules and tells @vikramchandra that the inoculation drive will pick up in August as the two vaccine makers will be able to manufacture over 17 crore doses per month.

Ask The Doctor | fewer tests leading to dip in Covid-19 cases? Experts break it down

As infections continue to dip in some urban&nbsp;centres, is it time to inch towards&nbsp;normacly? Why is the Covid-19 crisis a cause of worry?&nbsp;&nbsp;&nbsp;On today's episode,&nbsp;Dr Arvinder Soin&nbsp;Chairman at&nbsp;Medanta&nbsp;Liver Transplant Institute and National Lead Investigator, Indian RCT on Tocilizumab in Covid-19 is face to face with&nbsp;editorji&rsquo;s&nbsp;Vikram Chandra discussing&nbsp;the trends in rural India, and the new vaccination guidelines.&nbsp;Also&nbsp;one of the pioneers of imaging technology in India,&nbsp;Dr Harsh Mahajan&nbsp;who is Founder and Chief Radiologist, Mahajan Imaging,&nbsp;Dr Harsh Mahajan,&nbsp;talks about&nbsp;CT Scans&nbsp;and why they are unnecessary in most cases of infection.&nbsp;

Ask The Doctor | Covid-19 crisis in rural India, vaccination guidelines & CT scans: top experts answer

As infections continue to dip in some urban&nbsp;centres, is it time to inch towards&nbsp;normacly? Why is the Covid-19 crisis a cause of worry?&nbsp;&nbsp;&nbsp; On today's episode,&nbsp;Dr Arvinder Soin&nbsp;Chairman at&nbsp;Medanta&nbsp;Liver Transplant Institute and National Lead Investigator, Indian RCT on Tocilizumab in Covid-19 is face to face with&nbsp;editorji&rsquo;s&nbsp;Vikram Chandra discussing&nbsp;the trends in rural India, and the new vaccination guidelines.&nbsp; Also&nbsp;one of the pioneers of imaging technology in India,&nbsp;Dr Harsh Mahajan&nbsp;who is Founder and Chief Radiologist, Mahajan Imaging,&nbsp;Dr Harsh Mahajan,&nbsp;talks about&nbsp;CT Scans&nbsp;and why they are unnecessary in most cases of infection.&nbsp;

As infections continue to dip in some urban&nbsp;centres, is it time to inch towards&nbsp;normacly? Why is the Covid-19 crisis a cause of worry?&nbsp;&nbsp;&nbsp; On today's episode,&nbsp;Dr Arvinder Soin&nbsp;Chairman at&nbsp;Medanta&nbsp;Liver Transplant Institute and National Lead Investigator, Indian RCT on Tocilizumab in Covid-19 is face to face with&nbsp;editorji&rsquo;s&nbsp;Vikram Chandra discussing&nbsp;the trends in rural India, and the new vaccination guidelines.&nbsp; Also&nbsp;one of the pioneers of imaging technology in India,&nbsp;Dr Harsh Mahajan&nbsp;who is Founder and Chief Radiologist, Mahajan Imaging,&nbsp;Dr Harsh Mahajan,&nbsp;talks about&nbsp;CT Scans&nbsp;and why they are unnecessary in most cases of infection.&nbsp;

Ask The Doctor l When should a Covid-19 patient get a CT scan?

Ask The Doctor l When should a Covid-19 patient get a CT scan?

Ask The Doctor l Covid-19 in rural India a matter of concern?

Ask The Doctor l Covid-19 in rural India a matter of concern?

On today's episode of Ask The Doctor, Dr Sudipto Pakrasi, Chairman, Opthalmology, Medanta Medicity explains why cases of black fungus are rising across hospitals in the country. Busting common misconceptions on mucormycosis, Dr Pakrasi says immuno-suppression in Covid patients leads to black fungus infections, while over administering steroids may also lead to increase in mucomycosis cases. He assures, that the black fungus infection if detected early during diagnosis is completely treatable by available drugs &amp; there's nothing to worry.

Ask The Doctor | Common symptoms of black fungus infection & treatment

On today's episode of Ask The Doctor, Dr Sudipto Pakrasi, Chairman, Opthalmology, Medanta Medicity explains why cases of black fungus are rising across hospitals in the country. Busting common misconceptions on mucormycosis, Dr Pakrasi says immuno-suppression in Covid patients leads to black fungus infections, while over administering steroids may also lead to increase in mucomycosis cases. He assures, that the black fungus infection if detected early during diagnosis is completely treatable by available drugs &amp; there's nothing to worry.

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