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World COVID Meter 21st April

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Dr KK Aggarwal    21 April 2020

210 countries affected, over 2.48 M cases, Deaths cross 200,000 with current trend with minimum expected deaths over 178938, 21.9 deaths per million population

April 9 US: 9,282 healthcare workers, 723 hospitalizations and 27 deaths. India doubling time 7 days

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

1st 100,000 cases in 67 days, 2nd in 11 days, 3rd in 4 days, 4th in 3 days, 5th in 2.5 days, 6th in 2 days, 7th in 2 days, and subsequent in 1.5 days

First reported case: 10th January

Situation around the Globe

Likely minimum deaths (170423 + 56765 x 15 = 8515) = 178938   

Cases: 2,481,026 (73928 yesterday)

Deaths: 170,423 (5366 yesterday)

Recovered: 646,675

Active cases: 1,663,928

Currently Infected Patients

Mild: 1,607,163

Serious: 56,765 (3%)

CLOSED CASES

Outcome: 817,098

Recovered: 646,675 (79%)

Died: 170,423 (21%)

Cases per million population (Global) 318    

Deaths per million population (Global) 21.9

From first symptom to dyspnea (Shortness of breath) = 5.0 days

From first symptom to hospital admission = 7.0 days

From first symptom to ARDS (Acute Respiratory Distress Syndrome) = 8.0 days (when occurring)

Incubation period (time from exposure to the development of symptoms) = 2-14 days.

No data: Time to test positive to the onset of first symptom

India

 Confirmed 17615, Deaths: 559

Country,Other

TotalCases

NewCases

TotalDeaths

NewDeaths

TotalRecovered

ActiveCases

Serious,Critical

Tot Cases/1M pop

Deaths/1M pop

TotalTests

Tests/1M pop

India

18,539

+924

592

+33

3,273

14,674

 

13

0.4

401,586

291

Total:

2,480,503

+73,928

170,397

+5,366

646,328

1,663,778

56,763

318.2

21.9

  

India Cases on 21st: 18539; Cases on 12th: 9205

Doubling time: 8.5 days  

Growth factor > 1

GF = every days new cases/new cases on the previous day. For example, a quantity growing by 7% every period (in this case daily) has a growth factor of 1.07. A growth factor above 1 indicates an increase, whereas one which remains between 0 and 1 is a sign of decline, with the quantity eventually becoming zero, whereas a growth factor constantly above 1 could signal exponential growth.

Death Rate

Europe: 9.38% [cases 1,113,096; deaths 104491]

Asia: 3.06% [ 396,469 cases and 15132 deaths)

Oceania: 1.01% [8164 cases and 83 deaths]

North America: 5.33% [cases 851,396; deaths 45433]

Africa: 4.81% [24,171 cases with 1164 deaths]

South America: 4.71% [86,486 cases with 4079 deaths]

India: 3.19% [18,539 cases with 592 deaths]

Pakistan: 1.98% [8892 cases and 176 deaths]

World: 6.87 % [2,480,503 cases with 170397 deaths]  

Updates [DKA1] 

  1. 30% of Indian cases are from Tablighi Jamaat
  2. Extra pulmonary manifestations: Encephalitis, Guillain-Barré Syndrome (96 cases), diarrhea, loss of smell, loss of taste, AKI (5%, tremendously catabolic with hyperkalemia, hyperphosphatemia, and profound metabolic acidosis to a degree not seen in typical kidney failure patients); hepatopathy,conjunctivitis, diabetes and hyperglycemia among people without prior diabetes, thrombocytopenia (20.7%)
  3. Australia and New Zealand relax restrictions: Both countries have managed to keep the coronavirus outbreak mostly contained. For eight days in a row, Australia has recorded less than 50 new cases. [NY Times]
  4. Singapore’s coronavirus caseload has increased over two-fold in the past few days, with more than 8,000 confirmed cases as of Monday, the highest in Southeast Asia. Most new infections have been reported from the crowded dormitories where migrant laborers live. The rise has exposed the very different experiences of rich and poorer expatriates in a city-state where 40% of residents are foreign-born. [NY Times]
  5. Hong Kong reported no new coronavirus cases on Monday, the first time since a second wave of infections hit the city in early March. [NY Times]
  6. In Delhi, all the 186 novel coronavirus cases found positive on Saturday were asymptomatic.
  7. In New York City, in a universal testing of pregnancy trial, investigators found that 13.7% had COVID-19 infection (87.9% were asymptomatic and 12.1% were pre symptomatic)
  8. In India, it is affecting younger people (<50 years) with mild symptoms
  9. A pandemic is National Health Emergency
  10. All healthcare workers and on HCQS prophylaxis should fill the form https://www.surveymonkey.com/r/6KPW8CR
  11. India doubling time is >7 days
  12. Make healthcare establishments fully functional
  13. Concentrate on polio, measles, rotavirus, routine immunization and TB notification. Isolate all MDR and TB positive cases till sputum negative.
  14. Consider every surface and asymptomatic person as virus carrier.
  15. COVID-19 may assume a seasonal nature.
  16. BCG may be protective. ICMR has started a study. Cases in India 11 per million population against 299 global
  17. Diagnose and treat early to reduce viral load and prevent cytokine storm AND test after days (antibodies test will take 7 days to detect)
  18. Both ARDS and silent hypoxia require specific non ventilatory and ventilatory prone settings with standby ECMO. tPA, heparin, ACE inhibitors, early treatment, plasma therapy, blood/cord blood transfusion, timely air lift of critical patients may help.
  19. Post @ https://mobile.twitter.com/ChestImaging?s=08: Post COVID positive X rays, CT images.
  20. Collateral benefits: Reduction in air pollution, clear Ganges, reduction in overall deaths (low pollution, less stress, more hygiene, no traffic accident deaths).
  21. ZIKA Brazil Model: Army used for the crisis. Keep Army at standby.
  22. Quarantine models

India: Early lockdown for forty days

Wuhan: Selective sealing of epicenter

Vietnam: Sealing of a village with most cases

Bhilwara CLUSTER: Seal 2 km all around, fumigate each house, house to house survey for ALI and SARI, isolate infected cases, test all close contacts

Bird flu model: April 20, 2016, the Lebanese Ministry of Agriculture found H5N1 in 2 poultry farms on the border of Lebanon with Syria. Some 20,000 domestic birds died. The ministry culled all (60K) domestic birds within a 3-km radius. All farms were disinfected, and organic remains were disposed safely.

Germany, Sweden and Japan model: Selective isolation of elderly and high-risk comorbid patients

 South Korea: Intensify testing amongst all or high-risk groups

 Italy: Deploy younger healthcare workers and women as front-line fighters (2 hospitals posted young doctors < 40 years, 60% women on duties with no mortality in healthcare workers)

 Singapore: Make available surgical masks at reception to be worn by all patients entering the hospital. Give N 95 masks to all healthcare providers and use AII rooms for all procedures on infected cases.

Germany:  Random testing for antibodies is key in Germanys strategy. (New York Times)

  1. Convalescent plasma therapy: Start early to reduce viral load. One patient can give it to ten patients.
  2. Delhi HCW model: Keep all the healthcare workers on duty in hotels
  3. Significant exposure to COVID-19: Face-to-face contact within 6 feet with a patient with symptomatic COVID-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching COVID-19 from a passing interaction in a public space is minimal.
  4. Mask Policy: All health workers in healthcare setting should wear N 95/surgical masks and general public should wear cloth mask when on the roads.
  5. The cost of API used in hydroxychloroquine touched Rs 70,000 per kg, from Rs 6,500 per kg in February. The cost of API for azithromycin has doubled to Rs 16,000 a kg. China is a major supplier of APIs.
  6. Asix-day delay by China: On January 14, top Chinese officials sensed a pandemic. The head of Chinas National Health Commission, Ma Xiaowei, in a confidential teleconference with provincial health officials, said: "The epidemic situation is still severe and complex, the most severe challenge since SARS in 2003, and is likely to develop into a major public health event." Yet in the six days that followed, Wuhan hosted a banquet attended by thousands and millions of Chinese migrated within the country for the Lunar New Year celebrations. On January 20, President Xi Jinping warned the public, saying the outbreak "must be taken seriously". The same day, a leading Chinese epidemiologist, Zhong Nanshan, announced for the first time that the virus was transmissible from person to person on national television. But by then, more than 3,000 people had been infected.
  7. 12 days of silence added to the fuel: From Jan 5 to Jan 17, Chinas CDC did not register any case of pneumonia-like disease from local officials. Yet during that time, hundreds of patients were appearing in hospitals not just in Wuhan but across the country. On January 2, local officials of the Chinese Communist Party punished eight doctors for "rumour mongering" for warning friends on social media about the emerging SARS-like threat. One of the doctors, Dr. Li Wenliang, later died on Feb. 7.
  8. Two Chinese companies sold UK 2 M home test kits for $20 million on upfront payment on take it or leave it terms. The simple pregnancy test like option was a potential game changer but the tests did not work.
  9. More doubt on coronaviruss Wuhan origin: In a paper published earlier this month, geneticists said it may have started spreading as early as mid-September, and from elsewhere in China. (PNAS, Newsweek)
  10. The coronavirus crisis has killed more than 7,000 people at nursing homes across the country, The New York Times has stated, and has even ravaged facilities with sterling reputations.

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

World

2,480,503

73,928

170,397

5,366

646,328

1,663,778

56,763

318

21.9

  

USA

792,759

28,123

42,514

1,939

72,389

677,856

13,951

2,395

128

4,026,360

12,164

Spain

200,210

1,536

20,852

399

80,587

98,771

7,371

4,282

446

930,230

19,896

Italy

181,228

2,256

24,114

454

48,877

108,237

2,573

2,997

399

1,398,024

23,122

France

155,383

2,489

20,265

547

37,409

97,709

5,683

2,380

310

463,662

7,103

Germany

147,065

1,323

4,862

220

91,500

50,703

2,889

1,755

58

1,728,357

20,629

UK

124,743

4,676

16,509

449

N/A

107,890

1,559

1,838

243

501,379

7,386

Turkey

90,980

4,674

2,140

123

13,430

75,410

1,909

1,079

25

673,980

7,991

Iran

83,505

1,294

5,209

91

59,273

19,023

3,389

994

62

353,012

4,203

China

82,747

12

4,632

 

77,084

1,031

81

57

3

  

Russia

47,121

4,268

405

44

3,446

43,270

700

323

3

2,053,319

14,070

Brazil

40,743

2,089

2,587

125

22,130

16,026

7,919

192

12

291,922

1,373

Belgium

39,983

1,487

5,828

145

8,895

25,260

1,071

3,450

503

161,896

13,969

Canada

36,829

1,773

1,690

103

12,586

22,553

557

976

45

559,578

14,826

Netherlands

33,405

750

3,751

67

N/A

29,404

1,158

1,950

219

171,415

10,004

Switzerland

27,944

204

1,429

36

18,600

7,915

386

3,229

165

224,442

25,933

Portugal

20,863

657

735

21

610

19,518

215

2,046

72

235,878

23,133

India

18,539

924

592

33

3,273

14,674

 

13

0.4

401,586

291

Peru

16,325

697

445

45

6,968

8,912

385

495

13

148,011

4,489

Ireland

15,652

401

687

77

77

14,888

294

3,170

139

90,646

18,358

Austria

14,795

46

470

18

10,631

3,694

194

1,643

52

182,949

20,313

Sweden

14,777

392

1,580

40

550

12,647

521

1,463

156

74,600

7,387

Israel

13,713

222

177

5

4,049

9,487

149

1,584

20

240,303

27,763

Japan

11,135

338

263

27

1,239

9,633

217

88

2

116,725

923

S. Korea

10,674

13

236

2

8,114

2,324

55

208

5

563,035

10,982

Chile

10,507

419

139

6

4,676

5,692

377

550

7

118,827

6,216

Saudi Arabia

10,484

1,122

103

6

1,490

8,891

88

301

3

180,000

5,170

Ecuador

10,128

660

507

33

1,150

8,471

124

574

29

32,453

1,839

Poland

9,593

306

380

20

1,133

8,080

160

253

10

214,236

5,661

Romania

8,936

190

478

27

2,017

6,441

261

465

25

98,491

5,120

Pakistan

8,892

544

176

8

1,970

6,746

46

40

0.8

104,302

472

Mexico

8,261

764

686

36

2,627

4,948

207

64

5

49,570

384

Singapore

8,014

1,426

11

 

801

7,202

23

1,370

2

94,796

16,203

Denmark

7,515

131

364

9

4,312

2,839

84

1,297

63

96,244

16,616

UAE

7,265

484

43

2

1,360

5,862

1

735

4

790,000

79,875

            

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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