1^st April COVID-19 Update: Deaths will cross 50,000 in 202 countries, Minimum expected deaths - 46975  

1^st one lac got infected in 67 days, 2^nd in 11 days, 3^rd in 4 days, 4^th in 3 days, 5^th  in 2.5 days, 6th in 2 days, 7th in 2 days, 8th in 1.5 days

USA, Italy, Spain numbers cross China mark

First reported Case: 10^th January

India: 1397 cases, 35 deaths World Meter and MOH; 1619/49 (covid19india.org)

Maharashtra reported first 100 cases in 15 days, 200 in 6 days, 300 in 2 days

Tamil Nadu: Doubling time one day from 67 to 124

Strategies

1. Time to analyze if those who got BCG vaccination in childhood got the infection or not
2. Will India mandate all CSR funds be diverted to COVID-19 control and 100% exemption in income tax for any contribution to COVID-19 funds?
3. ARDS (cytokine storm) requires specific ventilator settings and trained staff. All hospitals should list their ARDS management qualities along with availability of ECHMO machine
4. https://mobile.twitter.com/ChestImaging?s=08 All should post their COVID positive X rays here. Similarly, one should post and share CT scan and lab parameters
5. The government should share district wise data and enlist all hotspots. Similarly, all private labs should disclose the number of positive lab samples on a common platform
6. In India, we expected reduction in cases starting 30th March in view of a Nationwide Restriction of movement on 22nd and Lock Down on 24^thnight (Mean incubation period 5.2 days). However, we did notice a jump in daily cases on 30^th March and 31^st March, but that was again due to a hotspot
7. Reduction in pollution levels; effect already seen in Delhi and Noida
8. Reduction in overall deaths from other causes (low pollution, less stress, more hygiene, no traffic accident deaths). The effect is already seen in Delhi’s cremation numbers. There is also a trend of shifting towards CNG cremation. One of the cremation grounds on 25th and 26^thshowed 20% reduction in deaths (just an observation)
9. After the Nizamuddin incidence, the government may impose National Health Emergency; take law and order, health and finance regarding COVID-19 in its hand or come out with a National Ordinance like Kerala.
10. ZIKA crisis in Brazil was successful only because of deployment of Army.
11. The government has an option of taking help of Final Year MBBS students, nurses with one-time extended prescription powers, foreign doctors waiting to pass entrance exam with some incentives, if crisis occurs.
12. The government also has the option of employing post MBBS students aspiring for PG, to be posted in COVID-19 duty and give them extra marks in PG NEET.
13. Options for containment: Lock down for three weeks (India model); Lock down for forty days; selective lockdown of states with rising cases (Wuhan model); Selective lockdown of cities with hot spots (Vietnam model); selective lock down for elderly and persons with comorbid conditions (Germany and Japan model); Intensify testing amongst all or high-risk groups (South Korea model); Deploy younger healthcare workers and women as front-line fighters (Italy - two hospitals posted young doctors <40 years, 60% women on duties with no mortality in healthcare workers); Make surgical masks available at reception to be worn by all patients entering the hospital (Singapore model).
14. Use the donated plasma of all cured patients for serious patients
15. Keeping all the healthcare workers on duty in hotels (like air lines staff) till the COVID-19 pandemic is over so that they are not a risk to their family
16. Protecting the lives of the medical and healthcare workers is crucial considering the tragic experiences in countries like Italy and Spain — 61 doctors have succumbed to the deadly virus in Italy while in Spain, 14% of those infected are doctors and healthcare workers. In China, the country of origin of the SARS-Cov-2 virus, till the first week of March, 3,400 healthcare workers had been infected with the virus while in Wuhan, where it was first reported, 18 doctors and other healthcare workers succumbed to the disease. [TOI]
17. A dozen doctors in five states have been infected mainly due to lack of masks, gloves and personal protection equipment (PPE).  Medical staffof Delhi’s Ram Manohar Lohia Hospital, which includes 6 doctors and 4 nurses, were quarantined after coming into contact with a COVID-19 positive patient that led to one of the nurses developing symptoms of the disease.

Situation around the Globe

Likely minimum deaths (42129 + 32297 x 15 = 4846) = 46975    

New cases on 31st March: 73099

New deaths on 31^st March: 4356

Cases per million population (global): 101.1

Deaths per million population (global): 5.4

Total cases: 857837

Deaths: 42129

Recovered: 177141

Active cases: 6385567

Currently infected patients Mild: 606270 (95%)

Serious: 32297 (5%)

 Clusters in India

1. Nizamuddin West in Delhi is linked to 9 deaths (6 in Telangana and one each in Srinagar, Tamil Nadu and Karnataka), 9 confirmed cases in Andaman and Nicobar Islands and 18 confirmed cases in Delhi. All of them had attended a religious congregation conducted by Tabligh-e-Jamaat from the first through the second week of March in Nizamuddin. Nearly 250 foreign nationals attended the event, who later travelled to other states in the country. Over 450 have developed symptoms including fever, cough and heavy breathing.

• Bhilwara in Rajasthan: 25 cases and two deaths. The infection came into notice after 6 doctors and medical staff at a private hospital tested positive.
• Kerala’s northern district of Kasargodrecorded 15 more cases, taking the total there to over 30.
• Dilshad Garden in Delhi

 Cases and Deaths across the World

Highlighted in green

= all cases have recovered from the infection

Highlighted in grey

= all cases have had an outcome (there are no active cases)

The "New" columns for China represent the previous day changes (China reports after the day is over). For other countries, the "New" columns represent the changes for the current day while still in progress.

(Source: https://www.worldometers.info/coronavirus/)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA