World COVID Meter 11th August:Acute immuno-inflammatory manageable virus disease with significant post-virus phase;213 Countries Affected |
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World COVID Meter 11th August:Acute immuno-inflammatory manageable virus disease with significant post-virus phase;213 Countries Affected
Dr KK Aggarwal,  11 August 2020
Coronavirus Live Count Map India

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COVID-19 Vaccine Updates

#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, 15M July 23, 16M July 25, 17M July 29, 18M August 1, 19M August 6, 20M August 10

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

Coronavirus Cases: 20,246,580

Deaths: 738,695

Recovered: 13,107,360

ACTIVE CASES: 6,400,525

Currently Infected Patients 6,335,998 (99%) in Mild Condition

64,527 (1%) Serious or Critical

CLOSED CASES: 13,846,055

Cases which had an outcome: 13,107,360 (95%) Recovered/Discharged

738,695 (5%) 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

20,238,946

+209,823

737,899

+4,341

13,100,684

6,400,363

64,545

2,596

94.7

   

1

USA

5,251,446

+49,800

166,192

+569

2,715,934

2,369,320

17,589

15,855

502

66,178,615

199,803

331,219,304

2

Brazil

3,057,470

+21,888

101,857

+721

2,163,812

791,801

8,318

14,373

479

13,231,548

62,200

212,727,180

3

India

2,267,153

+53,016

45,353

+887

1,581,640

640,160

8,944

1,641

33

24,583,558

17,795

1,381,493,158

 

 

Doubling Time

 

Date

Daily new cases

New Deaths

Total cases

Total Deaths

10th August

53016

887

2267153

45353

9th August

62117

1013

2214137

44466

8th August

65156

875

2152020

43453

7th August

61455

940

2086864

42578

6th August

62170

899

2025409

41638

5th August

56626

919

1963239

40739

4th August

51282

849

1906613

39820

3rd August

50629

810

1855331

38971

2nd August

52783

758

1804702

38783

1st August

54865

852

1751919

37403

31st July

 57704

 765

 1697054

 36551

30th July

 54966

 783

 1639350

 35786

29th July

52249

779

1584384

35003

28th July

49632

776

1532135

34224

27th July

46484

636

1482503

33448

26th July

50525

716

1436019

32812

25th July

48472

690

1385494

32096

24th July

48892

761

1337022

31406

23rd July

48446

755

1288130

30645

22nd July

45599

1120

1239684

29890

21st July

39168

671

1194085

28770

20th July

36810

596

1154917

28099

 

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:COVID-19 Pandemic is 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 arethen breathed or coughed out andinfect 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 has reported that clots are seen in patients even on blood thinners.
  6. Other human beta-coronaviruses has 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 returnafter 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 (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.

 

Formulas

  1. Deaths in symptomatic cases: Less than one percent (best of the care)

Therefore, Deaths X 100= expected number of symptomatic cases

  1. Cases after seven days: Cases today x 2 (based on doubling time 7 days, will change as per doubling time of the country)
  2. Cases expected in the community

Get number of deaths occurring in a five-day period

Estimate the number of infections required to generate these deaths based on the country or area 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

  1. Lock down effect = Reduction in cases after average incubation period (5 days)
  2. Lock down effect in reduction in deaths: Reduction in number of deaths on day 14 (average time to death of that country)
  3. Requirement of ventilators on day 9: 1-3% of number of new cases detected
  4. Requirement of future oxygen on day seven: 10% of total cases detected today
  5. Number of people which can be managed at home care: 90% of number of cases today
  6. Requirement of ventilators: 1-3% of number of cases admitted 7-9 days back
  7. Requirement of oxygen beds today: 10% of total cases admitted seven days back
  8. Case fatality rate: Number of total deaths as on date/number of total RTPCR positive cases as on today
  9. Infection fatality rate: Number of total deaths as on date/number of total calculated cases as on today
  10. Number of reported deaths = Number of confirmed deaths x 2
  11. Number of unreported or untested cases = Number of reported cases x 10-30 (depending on the country, New York 10, Delhi 23.8, Pakistan 30)
  12. 1Number of asymptomatic cases:For 6 symptomatic cases, 200 asymptomatic cases
  13. Oxygen requirement on that day in the hospital at 6am: Number of cases detected to have hypoxia on six minutes walk test.

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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