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World COVID Meter 8th June - 213 Countries affected: Wear mask at home

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Dr KK Aggarwal    08 June 2020

Cases: 1M April 2, 2M April 15, 3M April 27, 4M May 8, 5M May 20, 6M May 30, 7M June 7 

Ground Zero: Wuhan - in live animal market or cafeteria for animal pathogens: 10th January; Total cases are based on RT PCR, 67% sensitivity

Doubling time: India 14.5 days, USA 33 days, Brazil 13 days, Russia 18 days, Spain 47 days, UK 35 days, Italy 55 days, France 49 days, Turkey 37 days

Likely minimum deaths (405294 + 53752 x 15 = 8062) = 413357    

Cases cross 7 M and deaths cross 400K

Coronavirus Cases: 7,086,003

Deaths: 405,294

Recovered: 3,459,969

ACTIVE CASES: 3,220,740

Currently Infected Patients 3,166,988 (98%) in Mild Condition

53,752 (2%) Serious or Critical

CLOSED CASES: 3,865,263

Cases which had an outcome: 3,459,969 (90%) Recovered/Discharged

405,294 (10%) Deaths

909.1 cases per million population (India 187) 

52 deaths per million population (India 5)

India Doubling Time: 14.5 Days. India Crosses 257K cases

Serious 8944

Likely more deaths 1266

 

Country,Other

TotalCases

NewCases

TotalDeaths

NewDeaths

TotalRecovered

ActiveCases

Serious,Critical

Tot Cases/1M pop

Deaths/1M pop

TotalTests

Tests/1M pop

Population

1

India

257,486

+10,864

7,207

+261

123,848

126,431

8,944

187

5

4,666,386

3,384

1,379,122,578

 

Total:

7,082,212

+113,090

405,081

+3,382

3,456,944

3,220,187

53,752

908.6

52.0

   

28 Days

Date

Daily new cases

New Deaths

Total cases

Total Deaths

7th June

10864

261

257486

7207

6th June

10438

297

246622

6947

5th June

9471

286

236184

6649 (2.8%)

4th June

9889

275

226713

275

3rd June

9633

259

216824

6088

2nd June

8821

221

207191

5829

1st June

7761

200

198370

5608

31st May

8782

223

190609

5408

30th May

8336

205

181827

5185

29th May

8105

269

173491

4980

28th May

7300

177

165386

4711

27th May

7293

190

158086

4534

26th May

5843

172

150793

4344

25th May

6414

148

144950

4172

24th May

7113

156

138536

4024

23rd May

6629

142

131423

3868

22nd May

6568

142

124794

3726

21st May

6198

150

118226

3584

20th May

5553

132

112028

3434

19th May

6147

146

106475

3302

18th May

4630

131

100328

3156

17th May

5050

154

95698

3025

16th May

4864

118

90648

2781

15th May

3787

104

85784

2753

14th May

3942

98

81997

2649

13th May

3763

136

78055

2551

12th May

3524

121

74292

2415

11th May

3607

82

70,768

2294

India in top 6, Top 4 in new cases per day; Will be in top 5 in three days   

#

Country,Other

TotalCases

NewCases

TotalDeaths

NewDeaths

TotalRecovered

ActiveCases

Serious,Critical

Tot Cases/1M pop

Deaths/1M pop

TotalTests

Tests/1M pop

Population

 

World

7,082,212

+113,090

405,081

+3,382

3,456,944

3,220,187

53,752

909

52.0

   

1

USA

2,007,449

+18,905

112,469

+373

761,708

1,133,272

16,923

6,067

340

21,291,677

64,349

330,880,530

2

Brazil

691,962

+18,375

36,499

+542

302,084

353,379

8,318

3,257

172

999,836

4,706

212,463,372

3

Russia

467,673

+8,984

5,859

+134

226,731

235,083

2,300

3,205

40

12,721,549

87,175

145,930,700

4

Spain

288,630

+240

27,136

+1

N/A

N/A

617

6,173

580

4,063,843

86,920

46,753,690

5

UK

286,194

+1,326

40,542

+77

N/A

N/A

604

4,217

597

5,581,073

82,239

67,863,688

6

India

257,486

+10,864

7,207

+261

123,848

126,431

8,944

187

5

4,666,386

3,384

1,379,122,578

 

India predictions

  1. >90% of people are symptomatic within 2 weeks of infection.
  2. Death rate is deaths today vs. number of cases today.
  3. Corrected death rate is deaths today vs. number of cases 14 days back.
  4. For one symptomatic test positive case, there are 10-30 asymptomatic cases.
  5. Estimated number of deaths = Reported deaths x 2.
  6. Number of deaths today should be 15% of the serious patients present 14 days back.
  7. Undocumented cases for each documented case - Iceland: 1: 2; Germany: 1: 5; New York City grocery store shoppers: 1: 10;California 1.5%.
  8. Amongst active cases, 2.37% are serious, 1.82% need oxygen, and 0.41% need ventilator. support.

 

Extra Reading Background Material

  1. China: Captured tiny droplets of viral genetic markers in 2 hospitals in Wuhan floating for > 2 hours. Infectivity? [Journal Nature]
  2. India: In states with average population density of 1185/sq km, the average number of cases were 2048. On the contrary, in states with population density of 909/sqk 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]
  3. Revised COVID Sutras: It’s a COVID-19 pandemic due to SARS 2 Beta-coronaviruses (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 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 of copies of itself, which are then breathed or coughed out and infect others.
  4. 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].
  5. Viral particles seen in tears, stool, kidneys, liver, pancreas, heart, semen, peritoneal fluid, CSF.
  6. Thrombosis: University of Pennsylvania reports that clots are seen in patients even on blood thinners.
  7. Other human beta-coronaviruses have immunity lasting only for one year with no IMMUNITY PASSPORT.
  8. In absence of interventions, prolonged or intermittent social distancing (till 2022-24) is the key.
  9. Low levels of cross immunity from the other beta-coronaviruses against SARS-CoV-2 could make SARS-CoV-2 appear to fade away, only to return after a few years. Surveillance will be needed till 2024.
  10. During peak, trace and treat, and after the peak, trace and treat the close contacts.
  11. Increased spread: close environment, crowded place with close physical contacts with no ventilation.
  12. 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.
  13. HCW: Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.
  14. Italy: mortality reduced when they were short of ventilators.
  15. Hospital at HOME: CHF, mild pneumonia, exacerbations of asthma and COPD, cellulitis, and urinary tract infections.
  16. Great Imitator (protean manifestation).
  17. IgM can be false positive in pregnancy, immunological diseases; Pooled tests (< 5) when seroprevalence is < 2%.
  18. Early treatment to reduce the viral load and prevent cytokine storm using off label use of drugs like hydroxychloroquine 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.
  19. Hypoxia: Low flow oxygen < 6l/mt, titrated to high flow oxygen using non rebreathing mask, Venti mask, HFNC and helmet CPAP, NAV in supine or prone position.
  20. Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.
  21. Formulae: 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: 3% of number of new cases detected;  Requirement of future oxygen on day seven: 15% of total cases detected today;  Number of people that 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.

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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