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World Covid Meter 1st July - 213 Countries Affected

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Dr KK Aggarwal    01 July 2020

Cases: 1M April 2, 2M April 15, 3M April 27, 4M May 8, 5M May 20, 6M May 30, 7M June 7, 8M June 15, 9M June 22, 10M June 29 

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 20 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 (513861 + 57787 x 15 == 8669) =   522529

Coronavirus Cases: 10,583,932

Deaths: 513,861

Recovered: 5,794,565

ACTIVE CASES: 4,275,506

Currently Infected Patients 4,217,719 (99%) in Mild Condition

57,787 (1%) Serious or Critical

CLOSED CASES: 6,308,426

Cases which had an outcome: 5,794,565 (92%) Recovered/Discharged

513,861 (8%) Deaths

 

Country,Other

TotalCases

NewCases

TotalDeaths

NewDeaths

TotalRecovered

ActiveCases

Serious,Critical

Tot Cases/1M pop

Deaths/1M pop

TotalTests

Tests/1M pop

Population

 

World

10,577,756

+174,264

513,186

+5,072

5,790,762

4,273,808

57,787

1,357

65.8

   

1

USA

2,727,853

+46,042

130,122

+764

1,143,334

1,454,397

15,935

8,241

393

34,198,027

103,317

331,002,277

2

Brazil

1,408,485

+37,997

59,656

+1,271

790,040

558,789

8,318

6,626

281

3,070,447

14,445

212,558,178

3

Russia

647,849

+6,693

9,320

+154

412,650

225,879

2,300

4,439

64

19,562,440

134,049

145,934,619

4

India

585,792

+18,256

17,410

+506

347,836

220,546

8,944

424

13

8,608,654

6,238

1,379,974,505

5

UK

312,654

+689

43,730

+155

N/A

N/A

276

4,606

644

9,426,631

138,860

67,886,052

Doubling Time India 20 days, Delhi 15 days, Maharashtra 23 days

Date

Daily new cases

New Deaths

Total cases

Total Deaths

30th June

18256

506

585792

17410

29th June

18339

417

567536

16904

28th June

19620

384

549197

16487

27th June

20131

414

529577

16103

26th June

18276

381

509446

15689

25th June

18185

401

491170

15308 (3.11%)

24th June

16870

424

472985

14907

23rd June

15665

468

456115

14483

22nd June

13540

312

440450

14015

21st June

15183

426

426910

13703

20th June

13277

307

411727

13277

19th June

14721

366

395812

12970

18th June

13827

342

381091

12604

17th June

13103

341

367264

12262

16th June

11135

2006

354161

11921

15th June

10243

395

343026

9915

14th June

11382

321

333008

9520

13th June

12023

309

321626

9199

12th June

11320

389

309603

8890

11th June

11128

394

298283

8501

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/sq 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 other beta-coronaviruses against SARS-CoV-2 could make SARS-CoV-2 appear to fade away, only to return after a few years. Surveillance 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, Venturi mask, HFNC and helmet CPAP, NIV in supine or prone position.
  20. Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.
  21. 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: 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.

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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