World Covid Meter 20th July INDIA Number 3

Dr KK Aggarwal

Country, Other	Total Cases	New Cases	Total Deaths	New Deaths	Total Recovered	Active Cases	Serious, Critical	Tot Cases/ 1M pop	Deaths/ 1M pop	Total Tests	Tests/ 1M pop	Population
	World	14,634,732	+220,073	608,559	+4,316	8,730,163	5,296,010	59,809	1,877	78.1
1	USA	3,898,550	+65,279	143,289	+412	1,802,338	1,952,923	16,552	11,774	433	48,341,735	146,002	331,102,850
2	Brazil	2,099,896	+24,650	79,533	+716	1,371,229	649,134	8,318	9,876	374	4,911,063	23,096	212,636,496
3	India	1,118,107	+40,243	27,503	+675	700,399	390,205	8,944	810	20	13,791,869	9,989	1,380,678,271

Doubling Time  20 days

Date	Daily new cases	New Deaths	Total cases	Total Deaths
18th July	40243	675	1118107	27503
17th July	37407	543	1077864	26828
16th July	34820	676	1040457	26285
15th July	35468	680	1005637	25609
14th July	32682	614	970169	24929
13th July	28179	540	907645	23727
12th July	29108	500	879446	23187
11th July	27755	543	850358	22687
10th July	27761	521	822603	22144
9th July	25790	479	794842	21623
8th July	25571	491	769052	21444
7th July	23135	479	743481	20653
6th July	22510	474	720346	20174
5th July	23932	421	697836	19700
4th July	24015	610	673904	19279
3rd July	22721	444	649889	18669
2nd July	21948	377	627168	18225
1st July	19428	216	654405	17848
30th June	18256	506	585792	17410
29th June	18339	417	567536	16904
28th June	19620	384	549197	16487

India predictions

>90% of people are symptomatic within 2 weeks of infection

Death Rate is deaths today vs number of cases today

Corrected Death Rate is deaths today vs number of cases 14 days back

For one symptomatic test positive case there are 10-30 asymptomatic cases

Estimated Number of deaths = Reported deaths x 2

Number of deaths today should be 15% of the serious patients present 14 days back

Undocumented cases for each documented case [Iceland: 1: 2; German: 1: 5; New York City grocery store shoppers: 1: 10;California 1.5%]

Amongst active 2.37% are serious, 1.82% need oxygen, and 0.41% need ventilator support.

 Extra Reading Background Material

 China: Captured tiny droplets of viral genetic markers in 2 hospitals in Wuhan floating for > 2 hours. Infectivity? [Journal nature]

India: In states with average population density of 1185 /sk km the average number of cases were 2048. On the contrary in states with population density of 909/ sk km the number of cases were 56. (When Chandigarh and Pondicherry were taken out from this group) the Average Density of other states were 217 and the average number of cases were 35 [HCFI]

Revised COVID Sutras: It’s a COVID-19 Pandemic due to SARS 2 Beta Corona Viruses (different from SARS 1 where spread was only in serious cases); with three virus sequences floating (one similar to Wuhan, second similar to Iran and the third strain similar to USA – UK); has affected up to . 10%  (5.7 %  S Korea) of the population; Causes Mild or Asymptomatic Illness in 82%, Moderate to Severe Illness in 15%, Critical Illness in 3% and Death in 2.3% cases (15% of admitted serious cases, 71% with comorbidity< Male > Females); affects all ages but Predominantly Males (56%, 87% aged 30-79, 10% Aged < 20, 3% aged > 80); with Variable Incubation Period days (2-14; mean 5.2 days);  Mean Time to Symptoms 5 days;  Mean Time to Pneumonia 9 days, Mean Time to Death 14 days,  Mean Time to CT changes 4 Days, Reproductive Number R0 1.5 to 3  (Flu 1.2 and SARS 2), Epidemic Doubling Time 7.5 days; Origin Possibly from Bats (Mammal); Spreads via Human to Human Transmission via Large and Small Droplets and Surface to Human Transmission via Viruses on Surfaces for up to three days. Enters through MM of eyes, nose or mouth and the spike protein gets attached to the ACE2 receptors. ACE2 receptors make a great target because they are found in organs throughout our bodies ( heart muscle, CNS, kidneys, blood vessels, liver) Once the virus enters, it turns the cell into a factory, making millions and millions of copies of itself — which can then be breathed or coughed out to infect others.

Prevalence:New York: 13.9%; New York City at 21.2%, S Korea 5.7%, world 5%; Ohio prison: 73% of inmates; New York: 21% mortality April 22 in JAMA.

Viral particles seen in tears, stool, kidneys, liver, pancreas, heart, semen, peritoneal fluid, CSF.

Thrombosis: University of Pennsylvania clots are seen in patients even on blood thinners. Netherlands study, 31%

Other human beta-coronaviruses has immunity lasting only for one year with no IMMUNITY PASSPORT.

In absence of  interventions, prolonged or intermittent social distancing (till 2022-24)

Low levels of cross immunity from the other beta-coronaviruses against SARS-CoV-2 could make SARS-CoV-2 appear to die out, only to resurge after a few years. Surveillance till 2024.

During peak (trace and treat) and after the peak (trace and treat the close contacts

Increased spread: close environment, crowded place with close physical contacts with no ventilation

Strategies: From community mitigation to individual containment; broader good over individual autonomy; perfect cannot be the enemy of the good; pandemics are fought on the grounds and not the hospitals., Treat the patient and not the test report, Consider every surface and every asymptomatic person as virus carrier

HCW: Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.

Italy mortality reduced when they were short of ventilators.

Hospital at HOME: CHF, mild pneumonia, exacerbations of asthma and COPD, cellulitis, and urinary tract infections.

Great Imitator (protean manifestation)

IgM can be false positive in pregnancy, immunological diseases); Pooled tests (< 5) when seroprevalence is < 2%

Early treatment to reduce the viral load and prevent cytokine storm using off label use of drugs like hydroxy chloroquine with azithromycin; ivermectin, remdesivir; Tocilizumab interleukin (IL)-6 receptor inhibitor; convalescent plasma therapy ( given early; bridge compassionate therapy, donor 14 days symptoms free, single donation can help 4 patients), Lopinavir-ritonavir and Favipiravir).

Hypoxia: Low flow oxygen < 6l/mt, titrated to high flow oxygen using non breathing mask, Venti mask, HFNC and helmet CPAP, NAV in supine or prone position.

Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.

Formulas [Deaths in symptomatic cases 1; Deaths X 100= expected number of symptomatic cases; Cases after seven days: Cases today x 2 (doubling time 7 days); Cases expected in the community: Number of deaths occurring in a five-day period and estimate the number of infections required to generate these deaths based on a 6.91% case fatality rate; Compare that to the number of new cases actually detected in the five-day period. This can then give us an estimate of the total number of cases, confirmed and unconfirmed; Lock down effect = Reduction in cases after average incubation period (5 days); Lock down effect in reduction in deaths: On day 14 (time to death); Requirements of ventilators on day 9: Three percent 3% of number of new cases detected;  Requirement of future oxygen on day seven: 15% of total cases detected today;  Number of people which can be managed at home care: 80% of number of cases today;  Requirements of ventilators: 3% of Number of cases today;  Requirement of oxygen beds today: 15% of total cases today