World COVID Meter 24th July: India Number 3, 213 Countries Affected |
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World COVID Meter 24th July: India Number 3, 213 Countries Affected
Dr KK Aggarwal,  24 July 2020
Coronavirus Live Count Map India

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Coronavirus Live Count Map World

#Multispeciality

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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 29th, 11M July 4, 12M July 8, 13M July 13, 14M July 17

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 21 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

Coronavirus Cases: 15,651,605

Deaths: 636,464

Recovered: 9,535,213

ACTIVE CASES: 5,479,928

Currently Infected Patients 5,413,673 (99%) in Mild Condition

66,255 (1%) Serious or Critical

CLOSED CASES: 10,171,677

Cases which had an outcome: 9,535,213 (94%) Recovered/Discharged

636,464 (6%) Deaths

India races with Brazil

#

Country,Other

TotalCases

NewCases

TotalDeaths

NewDeaths

TotalRecovered

ActiveCases

Serious,Critical

Tot Cases/1M pop

Deaths/1M pop

TotalTests

Tests/1M pop

Population

 

World

15,641,978

+275,991

635,666

+6,309

9,530,013

5,476,299

66,261

2,007

81.6

   

1

USA

4,169,991

+69,116

147,333

+1,150

1,979,617

2,043,041

19,155

12,593

445

51,552,175

155,688

331,124,024

2

Brazil

2,289,951

+58,080

84,207

+1,317

1,570,237

635,507

8,318

10,768

396

4,911,063

23,094

212,652,984

3

India

1,288,130

+48,446

30,645

+755

817,593

439,892

8,944

933

22

15,075,369

10,918

1,380,826,432

Doubling Time 21 days

Date

Daily new cases

New Deaths

Total cases

Total Deaths

23rd July

48446

755

1288130

30645

22nd July

45599

1120

1239684

29890

21st July

39168

671

1194085

28770

20th July

36810

596

1154917

28099

19th July

40243

675

1118107

27503

18th July

37407

543

1077864

26828

17th July

34820

676

1040457

26285

16th July

35468

680

1005637

25609

15th July

32682

614

970169

24929

14th July

29842

588

937487

24315

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

India predictions

  1. Death rate is deaths today vs number of cases today.
  2. Corrected death rate is deaths today vs number of cases 14 days back.
  3. For one symptomatic test positive case, there are 10-30 asymptomatic cases and 20 untested cases.
  4. Estimated number of deaths = Reported deaths x 2.
  5. Number of deaths today should be 15% of the serious patients present 14 days back.
  6. Undocumented cases for each documented case - Iceland: 1: 2; Germany: 1: 5; New York City grocery store shoppers: 1: 10; California: 1.5%.
  7. Amongst active cases, 2.37% are serious, 1.82% need oxygen, and 0.41% need ventilator support.

Facts

  1. 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]
  2. 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 over eleven virus sequences floating; has affected up to 22.8% of Delhi population; Causes Mild or Atypical 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.
  3. 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].
  4. Viral particles seen in tears, stool, kidneys, liver, pancreas, heart, semen, peritoneal fluid, CSF.
  5. Thrombosis: University of Pennsylvania reports that clots are seen in patients even on blood thinners.
  6. Other human beta-coronaviruses have immunity lasting only for one year with no IMMUNITY PASSPORT.
  7. In absence of interventions, prolonged or intermittent social distancing (till 2022-24) is the key.
  8. 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 till 2024.
  9. During peak, trace and treat, and after the peak, trace and treat the close contacts.
  10. Increased spread: close environment, crowded place with close physical contacts with no ventilation.
  11. 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
  12. HCW: Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.
  13. Italy: mortality reduced when they were short of ventilators.
  14. Hospital at HOME: CHF, mild pneumonia, exacerbations of asthma and COPD, cellulitis, and urinary tract infections.
  15. Great Imitator (protean manifestation).
  16. IgM can be false positive in pregnancy, immunological diseases; Pooled tests (< 5, 20 Kerala, 64 Singapore RTPCR) when seroprevalence is < 2%.
  17. Early treatment, day 3-5, to reduce the viral load and prevent cytokine storm using hydroxychloroquine with azithromycin or ivermectin with doxycycline with IV remdesivir and IV single dose tocilizumab interleukin (IL-6 receptor inhibitor) if very high D-dimer and IL 6; convalescent plasma therapy (given early; donor 14 days symptoms free, between day 28-40, single donation can help 4 patients), Lopinavir-ritonavir and Favipiravir if very low CD 4 counts.
  18. 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.
  19. Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.
  20. 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); Requirement 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;  Requirement 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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