by Gautam I. Menon
Across the period of a week, starting around the 8th of August 2023, I transformed from being someone in reasonable, if not perfect, health, to being a patient confined to a hospital bed, effectively paralysed waist-down. That I knew that my condition could possibly deteriorate even further, to the point where I would have to go into an ICU, added an inescapable layer of stress. I managed to camouflage this concern, but it never really left my mind.
This is a personal story of an illness and subsequent recovery. I’ll narrate events much as they unfolded in real time, but I’ll also weave my narrative around the condition itself, its treatment, and lessons from my experience.
The back-story starts in July, 2023, overlapping into early August. This was a period of intense travel: 11 airports in about a month across and outside India. This travel was largely on work. Delhi, where I stayed, was a fixed point to which I kept returning. Along the way, during this period, I had acquired a persistent cough, largely dry, accompanied by what seemed to be a barely noticeable fever. This lasted a while, 2 weeks or more, exacerbated by the stresses of both incessant travel and work. I recall feeling drained of energy through much of the time. (A meeting we’d organized, on data science in health, and in which I’d particularly wanted to attend all the talks, was washed-out for this reason. I stayed in my room for much of the time, emerging only for select talks by friends and the group photograph.)
The last leg of my travels was a brief trip out of India, at least partly to recharge before beginning to deal with the rigours of a teaching semester. The cough wore off and so did the exhaustion that had accompanied it. I threw myself into simply being a tourist in a foreign country, walking long distances to see places I hadn’t been to before. This was a country I had grown to love, across two previous visits. It helped that there were a number of friends there, old and new.
The weather was, as usual for that time of year, glorious. The cafes were brimming with people. The ferry trips were exactly as I remembered them from previous visits, with the summer light glancing off the ripples and waves, in shades of blue, seemingly as if reflected from a mirror shattered into a million pieces. My first inkling that something was wrong was a persistent tingling, a pins-and-needles feeling, on the soles of my feet, on August 9th. The sensation stayed with me. It was a more intense feeling than I had ever encountered previously. By the following day, the 10th, the same sensation had spread further. It was now but also in my hands, particularly in my fingers and palms.
By the third day, August 11th, I noticed some difficulty in walking. I couldn’t quite put my finger on what exactly had changed. It seemed as if my legs might choose to buckle a bit under me, except that they never actually did so. I found myself asking to take taxis instead of walking, even though walking anywhere would have been my normal choice. It was a subtle feeling, as if I had only limited control over what my legs were doing, as if they could proceed independently of me if they chose to.
I woke up in the morning of the fourth day, on the 12th, at about 6 AM. I found, to my dismay, that the weakness in my legs was now far more prominent. It was now genuinely hard to walk. I could hold myself up and stand on my feet, but even putting one foot in front of another felt strange. It seemed almost as though I was floating. The physical link between my upper body and my lower limbs felt as if it was becoming more tenuous.
I tried to put together what I knew. This was clearly a neurological condition, with the constant and oppressive pins-and-needles sensation pointing towards this interpretation. It was getting worse, and that too fairly fast, since it had now begun to interfere with my mobility within three days of initial symptoms. It was clearly ascending: it had started with the lower extremities and was now moving inexorably upwards.
As it happens, somewhat unusually, I actually had some idea of what this cluster of symptoms might be pointing to. I had at some point read about an unusually rare neurological condition called Guillain-Barre syndrome. I remembered a description of its onset which seemed to be similar to what I was experiencing.
Guillain-Barre syndrome (GBS) is a neurological condition. Though first identified in 1859, it is named after two French physicians who treated WW-1 soldiers more than 50 years later. (A syndrome typically refers to a cluster of symptoms, sometimes but quite often not particularly well defined, for which a direct cause is not established, such as an infection by a specific micro-organism.)
In GBS the immune system attacks parts of the peripheral nerves, those nerves located outside of the brain and spinal cord. The nerves in our body are sheathed in a cover of a protein called myelin. Myelin helps in regulating the conduction of electrical impulses along nerves. In GBS the immune system attacks this myelin sheath, leading to muscle weakness, an inability to control the legs and arms, and a loss of sensation.
GBS can affect anyone at any age, although it is more common in adults. It is rare. One estimate suggests that it affects about one person in 100,000 each year. While it isn’t contagious, there may be connections to an individual’s genetic make-up. There are varieties of GBS, but this needn’t concern us at the moment, since I was afflicted by the most common one.
GBS typically follows a viral or a bacterial infection, although at least in 30% of cases such an infection may be innocuous enough that a patient might easily forget about it. (It can also occur, though very rarely, as a consequence of a vaccination.) For some patients, GBS can lead to paralysis of the legs, arms, or muscles in the face. In about 30% of those afflicted, the chest muscles are affected and the ability to breathe, speak or swallow may thus be impaired. This requires immediate ICU admission.
No one understands how an infection might lead the immune system to be destabilised enough for GBS to occur and for the immune system to begin attacking its own, as it were. This is an important and central question in immunology: How does the human body recognise the proteins it makes from other, foreign ones? And when does this recognition break down, leading the immune system to attack the body it is embedded in? What sets GBS apart is the relative speed at which the deterioration happens, unlike some other neurological conditions where symptoms might progress across months and years, rather than just days.
About 8% of GBS patients die. This may not be a direct consequence of the disease, but an indirect one, such as from blood clots, infections acquired during hospitalisation and cardiac arrest. However, a vast majority of the rest make a full recovery over times ranging from a few months to a year or more. Only in rare instances are there lifelong consequences, typically chronic pain and fatigue, accompanied by other neurological symptoms.
The course of GBS is a characteristic one. The initial pace of decline, as described here, is sharp, with much of the deterioration happening across a period of a few days to weeks. The patient’s condition then attains a plateau, with little change, for what can be a variable length of time. Thereafter, improvement starts, although the pace of this improvement can vary from person to person.
Treatments of GBS are of two kinds, both different types of immunotherapy. IVIG refers to the administration of intra-venous (IV) antibodies, (immunoglobulins) (IG). An alternative approach is plasmapheresis, where antibodies are filtered out of the bloodstream.
Intriguingly, these two ways of treatment would appear to be opposed to each other. In one case you add antibodies, while in the other you remove them. However, these are currently considered the two frontline ways to treat GBS. They are believed equivalent: whether a patient is administered one or the other is largely the treating physician’s personal choice, although the ease of administering one or the other also counts. Both are very expensive treatments.
I carefully considered the odds. I then woke up A to tell her that I thought we should return immediately. This was a difficult decision, to cut short a trip that we’d barely begun. But I did not want to be in hospital in a foreign land, especially one in which we did not speak the language.
I spoke to friends in Delhi, in particular to a colleague Dr. AA, both doctor and scientist, who I thought would be perfectly placed to offer advice. I described my symptoms and asked what he suggested. His advice was succinct: Return immediately and go to hospital. He said he would set this up at the best place he knew, close to our home. I would get the highest quality of treatment there. The condition would certainly deteriorate but this might be the right window to leave. Any later was risky.
We spoke then to a local doctor, a friend of a friend. I described my symptoms again and asked her what she would recommend. I could either go to hospital there to get it checked out, or go to hospital there to be admitted or, finally, try to return as soon as possible.
Her advice was as clear as AA’s. It was better to return immediately, while I still could. To achieve any degree of certainty about the diagnosis would take a time and then the doctors might not recommend travel at that stage.
Given the choice of going to hospital there versus returning, she felt that returning would be better, provided it could happen as soon as possible. She would prescribe a mild steroid which would hopefully tide me through the flight. She sent us her prescription as a WhatsApp image. We walked to a nearby pharmacist to fill the prescription.
By this point, A was convinced. She spoke to the travel agent to change the tickets. Luckily there were tickets on the evening flight that very day. We asked for a wheelchair.
After that, A had to pack, since I was not in any state to help. The apartment had to be shut down and the keys returned. A taxi was summoned. A loaded all our luggage onto it, again without any help from me. I managed the walk to the taxi. We went early to the airport.
At the airport, all our luggage was loaded onto a trolley which A had to push. I could walk, slowly, but could not do much else. Unfortunately, the wheelchair could be accessed only after a first round of security. We crossed this particular hurdle and then went to the special assistance counter. We had to wait there until the wheelchair materialised. Once it did, accompanied by a taciturn attendant, I shifted to it. This was my first time in a wheelchair.
One advantage of being on a wheelchair in an airport is that one speeds through both immigration and security, since there are special lines for wheel-chair bound passengers. We navigated these fast. We were then taken, through mysterious winding ways, to a point where a large number of similar wheel-chair-bound passengers were waiting. I managed to walk on my own to the toilet, still with the sensation that my lower limbs were seeking autonomy from the rest of my body.
By then A had also spoken to her cousin, a medical professional in the US. Her cousin was aghast that we were travelling, given my state. Her worry was that if I went into any sort of respiratory distress on the flight, there would be little that the plane staff might be able to do. She said that had the airline known of my condition, they might not even have permitted me to fly. She urged that we reconsider our plans and return to the city immediately to go to hospital there.
I was aware of this risk. But I was also navigating on my personal sense of the rate of progression of the condition. I felt, strongly, that this was a window that could not be allowed to pass, one in which I could still manage the flight and reach the hospital in India before anything worse happened.
I spoke to A’s cousin myself and conveyed my confidence in my judgement, although I sensed that she was less than convinced. I said I’d be especially careful to look out for symptoms of either difficulty in swallowing or breathing, two indicators that the increasing incapacity of my muscles to obey my nerves had spread to an increasingly dangerous point.
We got onto the flight, luckily with seats that enabled easy access to the toilets. I walked there twice during the approximately 8 hour flight, albeit with some minor difficulty. The flight reached on time and our luggage arrived fast. The driver was waiting and we went home. By now it was about 7 in the morning.
At home, after resting briefly, I decided to wash up. I managed even to have a bath, although I could sense an increasing tremor in my hands. I was extra careful in getting in and out, given the increased reluctance of my limbs to cooperate.
After this, I went to the dining table to have a coffee. I discovered that I could not hold the cup steadily. My hands were shaking so much that the coffee was in real danger of spilling. It was hard to raise the cup to my mouth.
We decided then that we could delay no longer. We went to the hospital, to the emergency in the neurology department. I got off from the car straight into a wheelchair, and was wheeled in. They had been informed of my coming. I was examined and my vitals measured. I provided a quick history of my symptoms and how they had progressed. They asked me to walk a few steps forward and backward. This was recorded on a cell-phone video, which was then sent to the neurologist. I was then given a bed in emergency, luckily not too crowded on a Sunday morning.
After my condition was reviewed, the neurologist said I had to be admitted immediately. They would start right-away with a large dose of immunoglobulins. My condition would likely deteriorate further, but the crucial thing to watch out for was any difficulty in swallowing or breathing. This would automatically mean that I would have to be admitted to the ICU.
The next few hours were occupied in finding me a room, entering my name and details into the hospital system, paying an initial deposit, and beginning the IV dose. I was hooked up to a drip by about 2PM. I was initially sent to a room meant for two patients. We had asked for a single room, but that had to wait till one was available, which was not till the next day.
The day after I entered the hospital, I was asked to do an MRI, for my head and spine, to rule out other possible origins of my condition. This was something I dreaded.
An MRI machine looks like a large metal tube. You lie down on a movable table that slides into the tube. At this point, your head and most of your body are contained inside the tube, with the walls of the tube just a few inches above your head.
The machine is noisy, in fact very noisy. The patient must thus wear earplugs. It is important that they do not move while the scan proceeds. The patient’s head must thus be immobilised. The entire scanning process takes about half-an-hour.
I knew all this. But I had an associated difficulty to contend with. I’m claustrophobic. The very idea of being in a space as confined as the interior of an MRI machine, that too with my head placed in a restraint, filled me with dread. (While I’m OK in lifts, at least so far, there was something about the very thought of an MRI machine that was anxiety-inducing in the extreme. Indeed, I found that even listening to a news report about a cave explorer trapped in a cave in Turkey about a kilometre below the surface was sufficient to cause me some mental distress.)
I went to do the MRI, going as far as lying down on the movable table while it slid it. But a minute or so into the scan, I decided I could not do it, pressing the button that would call the MRI machine operator. I was sent back to my room.
By evening, they asked again. This time, having examined my options, I decided to brave the MRI machine once more. It was a different, more solicitous, operator. I told him of my difficulty and got him to promise that he would cut the process short and immediately rescue me if I used the button to summon him.
I was loaded into the machine. I closed my eyes tightly shut and simply counted every second. The wait, as the machine roared and clicked, seemed interminable. I concentrated on my breathing. Just when I thought I could bear it no longer, the scan ended. I was returned to my room.
By the following day, even the little ability I had to walk on my own feet began to vanish. I found that I could barely move my legs or even my toes. It was as if I was very largely paralysed from my waist down in terms of being able to move, although I could still sense my limbs. It was an unusual and profoundly disturbing feeling, to be dissociated from my lower limbs altogether. My hands would shake violently if I held them up. Only if they were placed in a completely relaxed position did the shaking cease.
Over the next few days, even the very limited ability to move my toes and lower limbs that I had when I entered hospital evaporated. Whatever I tried, they stubbornly refused to respond. I could not turn on my side. I had to be lifted, with two attendants on either side, to go to the bathroom. I could only lie down in bed, since I lacked the ability to sit up. The hospital bed could be raised and lowered in each of its articulated parts, but I didn’t have the motor ability to even press the buttons that would do this. I could hold my phone in my shaking hands with difficulty but could not press any buttons or even enter a message.
The specialist, Dr RR, would come every day, pretty much at the stroke of 10 AM. I would wait for his cheery greeting, his response to my description of my current state. He would ask me to hold my hands up and to move my legs, searching for every both of change and response since the previous day.
Once he discovered that I was a scientist with an interest in health and disease, his descriptions became more technical. He shared some technical reviews with us, devoted to GBS. Throughout he was relentlessly positive, a perfect antidote to my own sense of worry and uncertainty regarding the progression of the disease.
However, it was hard to see, particularly in those early days, that there could ever be light at the end of this tunnel, however reassuring his pronouncements.
By then the news of my illness had spread to friends. I had to inform my office, of course, that I would have to spend some part of the coming weeks if not months in hospital. Some friends who learnt about my illness asked if they could come to visit. I was happy to see those who came, although I felt guilty that I was the reason for their having to travel a long distance just to spend some time with me.
Given that large numbers of my own friends are scientists, in particular biologists, my room during visiting hours also became a place for discussions about immunology. I enjoyed these discussions. For a while, it seemed as if I could view my condition entirely dispassionately, contemplating my own immune system gone awry in the abstract.
I learnt of others who had gone through similar experiences, some of them far worse than mine, but had then recovered fully. (Dr RR sent two such recovered patients to talk to and reassure me, each with an equally horrifying story.) I heard of months spent in the ICU, and of “ICU psychosis”, which afflicts some who are confined there for long periods. That I had avoided the ICU seemed a lucky break.
By the fourth or fifth day in the hospital, Dr RR seemed visibly relieved that the more dire aspects of GBS had not kicked in yet. He was still watchful, but seemed altogether more positive that, given that I had stayed out of the ICU so far, it was increasingly unlikely that I might have to be admitted there. It was time for physiotherapy.
In disorders such as GBS, where the normal signals between nerves and muscles are interrupted, a prominent concern is that the muscles, in the absence of appropriate communication, might become weak and unable to function. Physiotherapy is thus an essential part of the rehabilitation process.
The hospital had a dedicated physiotherapy section. Every day, at 11 AM and 4PM, an attendant would arrive with a wheelchair to take me there. The room dedicated to this was a large one, with beds and tables and a battery of impressive-looking and gleaming metallic devices, some of them looking as if they were taken from a science-fiction movie.
The physiotherapy section was manned by a large number of young people, both men and women. It was their presence that made what might otherwise have been an unpleasantly exhausting experience, bearable. I gradually got to know most of them over the course of the following weeks.
A physiotherapist’s job is an exacting one. They must push their patients to the limit, coaxing their recalcitrant bodies to move and bend in unaccustomed ways, so that their muscles can re-learn their functions. (Doing this for 10 hours or more a day is also physically exhausting.) But they must also be counsellors, providing the right encouragement while also pushing their patients to do more.
My physiotherapy took many forms. The simplest was ‘rehab’, which involved exercising my hands and feet through a variety of repetitive tasks. Then there was ‘ADL’ or assisted daily living, an attempt to recover finer motor control through a series of hand exercises. There was ‘FES’, an electrical simulation technique that involved attaching a set of electrodes to my thigh, forcing the muscle to contract under stimulation.
Later, ‘biofeedback’ would be added, a method somewhat like the FES, but where the stimulation had to be accompanied by moving the relevant limb. And finally, there was the act of walking itself, with support from a large walker, substantial enough that it was hard to topple.
When I was first wheeled into the physiotherapy room and transferred into the bed, I could do absolutely nothing on my own. I was a fully passive participant, with my legs having to be picked up, slid and bent, all without any involvement from my end. My initial steps at the ADL were similarly disheartening. Even the simple act of sliding a block along a line was impossible.
But the most traumatic for me were the attempts at making me walk. I would be lifted, practically draped, along the large walker, with two people to assist me. I would be urged to at least take a tentative step, but the sheer impossibility of putting even the most limited weight on my legs or getting them to even move at all in the first place precluded this. I would hold on to the bars for dear life until rescued and hoisted back onto the bed. I have never felt as helpless.
But what made all this manageable was getting to know the young people entrusted with making me do these tasks. Most were trained in Delhi. They were proud of what they did. They enjoyed their work because it had a tangible outcome. They spoke of their happiness at seeing someone who couldn’t walk when they came in, take their first tentative steps on their own.
Many had, on their own, and given the diversity of patients who came to the hospital, learnt smatterings of Arabic and other languages, so as to be able to speak to them. It was because of them that I could summon up the energy and motivation to go twice a day for my sessions, usually about an hour and a half to two hours each. We would speak of many things while I tried my hand at the ADL exercises: the India-Pakistan cricket match, their own training, their interests, the foibles of other patients and their hopes for the future. I got to know some of the other patients, many in far worse shape.
Even though the physiotherapy sessions were exhausting in the extreme, a strange rhythm seemed to emerge as the days passed. But in tandem, I began to see a tangible improvement in my condition. My ADL tasks became surprisingly easy. At one point, I refused to do them any more, on the grounds that they had become too straightforward.
I could slowly lift up my feet a few centimetres, with the amount increasing each day. The visit of Dr RR in the mornings would commence with my demonstrating this day-to-day improvement in my condition. My rehab sessions grew to incorporate even more exercises.
One turning point for me was simply recovering the ability to turn on my side. This wasn’t straight-forward initially. I had to grab the bars on the side of the bed to be able to lie on my side. But given that this had been totally out of the question previously, it was a remarkable change. It was then that I allowed myself to begin to think that things might actually be changing for the better.
It was also time to ask the doctor about discharge. We both agreed that the ability to at least go to the toilet on my own, without any help, was psychologically important. He felt that I would be able to do this, with the aid of a walker, in a week. This would be September 15th, more than a month since I first entered hospital, and somewhat more than 5 weeks after my symptoms first appeared.
I had grown accustomed to the rhythm of the hospital – the repeated checking of my vitals, the endless measurements of my blood sugar, the multiple pills and injections administered around the clock, the fact that there would hardly be a space of even an hour during the day where I could be free from some nurse, doctor or other hospital functionary checking on me or my having to go for another physiotherapy session. But the delicious sense of wanting to sit at my own desk again, to sink into my sofa, to navigate familiar home territory, was something I dreamed of.
I finally left the hospital as planned. I had made a number of friends there, mostly nurses from the southern Indian state of Kerala who had tended to me, but really at all levels of the hospital. We took photographs together and with the nurse superintendent. Many of the others I knew were not there, since it wasn’t their shift, so I ensured that messages were left for them.
I then used the walker to navigate to the car. This was a longer walk than I had ever attempted in hospital. My thighs and hip hurt, but I concentrated simply on moving slowly, shuffling one leg in front of the other. I had lost my orientation within the hospital, since I’d come in from the emergency entrance and then never moved anywhere except between my room and the physiotherapy room for the past 5 weeks. As I emerged into the light of the patient registration area, everything seemed newer, fresher, and brighter than I could have imagined.
From room to the car took me about 10 minutes. The brief ride home took even less.
I would have to continue to do physiotherapy for several weeks, if not months, to coax my legs into helping me walk without the aid of a walker. Practice in walking would have to be accompanied by exercises that would add strength to those muscle groups involved. (As my friends in physiotherapy told me, the act of walking was possibly the most complex example of multiple muscles coordinating their action.) All of this lay in wait for me, with the silver lining being that the pace of my recovery was fast enough that Dr. RR seemed to think that I could possibly be walking on my own before the month was out.
This is a good point to end this particular story. But it’s also a good time to step back to explore a broader frame. My story was, in virtually all respects, atypical. I had the advantage of possibly the best treatment available in India. The quality of this treatment was likely even better than what I might have got in most parts of the developed world. I was covered by private medical insurance. My employers helped beyond any reasonable expectation. I could not have been supported more by family, friends and most especially my partner.
In India, the world’s largest democracy and among its most unequal ones, discussions of public health have struggled with questions such as the following: The cost of treatment for a serious illness can bankrupt families, forcing them into poverty to save the life of a loved one. India’s flagship Ayushman Bharat, its public insurance scheme for the poor, guarantees upto 5 lakh rupees per family per year for secondary and tertiary care hospitalisation. Premiums are paid for by state and central governments. (While this, in principle, covers about 40% of India’s population, that still leaves 60% very largely uninsured against catastrophic illness.) The costs of treating a severely ill GBS patient would exceed this insurance limit by a substantial amount. How does one deal with this?
This is separate from questions of access. Would a person from any part of India faced with the situation I was in, be guaranteed a correct diagnosis and appropriate treatment? In fact, if we knew the mismatch between number of recorded GBS cases and the numbers we might reasonably expect in a country of this size, we could infer what fraction of patients might not be diagnosed.
A young PhD student who came to see me for her research into GBS told me that, across the Delhi NCR (National Capital Region) region and parts of the neighbouring state of Haryana, she was able to find just 35 patients who she could get samples from. In the USA, with a population of about 330 million, about 3000-6000 people develop GBS each year.
A ball-park figure for cases can be estimated using 33 million as a representative guess for the population of the Delhi NCR region. If we just took the US fractions, this would mean about 300-600 cases might be expected for the NCR. The problem, of course, is the lack of data on diagnosed cases. What fraction of such cases are lost to follow-up? Could a large fraction of such cases be missed from the outset because the patient never went to a hospital? Is there a lower GBS incidence in the subcontinent? Clearly it would be of interest to find out which of these was true.
In conversations with clinician-scientists, those with a clinical training who have moved to primarily doing biomedical research, I have often been struck by how little is known at a fundamental level about large classes of disease conditions; indeed, how little is even known about mechanisms for how different drugs act within the human body. Doctors, of course, do the best they can in the face of limited information, relying on constantly scanning the relevant literature to search for changes in treatment protocols.
But the gold standard for understanding how a specific drug or treatment works – a randomized control trial or RCT as it’s called – is often unfeasible or, in some cases, even unethical, to carry out. The decision that favours one course of treatment over another can often be based on old papers reporting results that have stayed embedded in the literature because updating them was not considered worthwhile enough.
The technical literature on GBS seemed to me similarly tentative. What’s known is that both IVIG and plasmapheresis seem roughly equivalent in terms of patient outcomes and there seems to be relatively little advantage in further doses of IVIG for most patients. Against that, even the efficacy of IVIG in shortening time to recovery seems to have been demonstrated only in a specific class of patients, in data primarily on western, white populations. Clearly, we need more data on non-western populations to be able to customise treatments better.
Remarkably, the actual biological mechanisms by which either of these treatments work appears ill-understood. This points to why biology in general is unusual (and human physiology in particular, as a reference of interest) in comparison to the other sciences. We can measure the temperature of the universe, we can measure lengths that are a hundred times smaller than the width of the nucleus of an atom, we can measure quantum properties of atoms with accuracies that reflect ten decimal places. But we don’t yet know the answers, at a level of a deep enough mechanistic understanding, to a number of seemingly obvious questions about disease and the living human body.
An enforced stay in hospital is a wonderful aid to reflection. What made my own body respond as it did? Reduced immunity and exhaustion from a punishing schedule of travel and meetings played into this. Travel messes up the body’s internal (circadian) clock in complex ways. The disruption of circadian rhythms impacts immunity.
My infection lasted longer than it should have because I didn’t give myself the chance to rest. By the time I could get around to taking a break, the damage had, of course, been done.
One take-away from my experience is the need to slow down, to simply “stop and smell the roses”. But another one is that an active network of friendships and relationships is central to psychological sustenance in such times of crisis.
I could manage in hospital because I felt cared for and loved. I might not have recovered faster as a consequence, but this knowledge made dealing with my condition far easier, even when it was at its worst.
***
Gautam Menon is Dean (Research) and Professor of Physics and Biology at Ashoka University, Sonepat. He is also the Director of its Centre for Climate Change and Sustainability and a Commissioner for the Lancet Commission on Epidemiological Modelling. He serves on the scientific review committees of several international and national agencies, including the Human Frontier Science Program and the Wellcome Trust-DBT India Alliance. He has written extensively for the general public on topics at the interface of science and society, has appeared many times on TV and has been quoted across multiple other media, both nationally and internationally, during the COVID-19 pandemic. A short video clip featuring his COVID-19 recommendations, made for the Ministry of Health and Family Welfare, has been viewed close to a million times. In 2022, Apolitical named him in its list of 100 most influential academics in government worldwide.