Cases:1M: April 2, 2 M April 15, 3 M: April 27, 4 M May 8; 5 M 20 May, 6 M 30^th May, 7 M 7^th June, 8M by 15 June, 9 M 22^nd June, 10 M 29^th June. 11 M 4^th July, 16 M, 17 M 29 July, 18 M 1^st August 21 .8 M 16 August, 25 M 30^th August, 28 M 10 September,

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

Coronavirus Cases: 29, 188, 603

Deaths: 928, 325

Recovered: 21,031,679

ACTIVE CASES 7,228,599

Currently Infected Patients 7,168,098 (99%) in Mild Condition

60,501 (1%) Serious or Critical

CLOSED CASES 21,960,004

Cases which had an outcome: 21,031,679 (96%) Recovered / Discharged

928, 325 (4%) Deaths

India

India- USA New cases per day: 61358 difference

Total difference 1863455

With this speed India may cross USA by 18^th October (30.4 days from today)

13^th September: New cases 93215, New Deaths 1140, Total Cases 4845003, Total Deaths 79754

12^th September: New cases 94409, New deaths 1108, Total Cases 4751788, Total Deaths 78614

11^th September: New cases 97654, New deaths 1202, Total Cases 4657379, Total Deaths 77506

10^th September: New cases 96760, New deaths 1213, Total Cases 4559725, Total Deaths 76304

9^th September: New cases 95529, New deaths 1168, Total Cases 4462965, Total Deaths 75091

8^th September: New cases 89852, New Deaths 1107, Total Cases 4367436, Total Deaths 73923

7^th September: New Cases 75022, New Deaths 1129, Total cases 4277584, Total Deaths 72816

6^th September: New cases 91723, New Deaths 1008, Total Cases 4202562, Total Deaths 71687

5^th September: New cases 90600, New deaths 1044, Total Cases 4110839, Total Deaths 70679

4^th September: New cases 87115, New deaths 1066, Total Cases 4020239, Total Deaths 69635

3^rd September: New Cases 84156, New Deaths 1083, Total Cases 3933124, Total Deaths 68569

2^nd September: New Cases 82860, New deaths 1026, Total cases 3848968 Total Deaths 67486

1^st September: New cases 78169, New deaths 1025, Total cases 3766108, Total deaths 66460

31^st August: New cases 68770, New Deaths 818, Total cases 3687939, Total deaths 65435

30^th August: New cases 79457, New deaths 960, Total cases 3619169, Total deaths 64617

29^th August: New Cases 78472 New deaths 944 Total cases 3539712 Total deaths 63657

28^th August: New Cases 76665, New Deaths 1019, Total cases 3461240, Total deaths 62713

27^th August: New Cases 76826, New Deaths 1065, Total cases 3384575, Total deaths 61694

26^th August: New cases 75995, New deaths 1017, Total cases 3307749, Total deaths 60629

25^th August: New cases 66873, New Deaths 1066, Total cases 3231754, Total deaths 59612

24^th August: New cases 59696, New deaths 854, Total cases 3164881, Total deaths 58546

23^rd August: New cases 61749, New deaths 846, Total cases 3105185, Total deaths 61749

22^nd August: New cases 70068; new deaths 981; Total cases 3043436; Total Deaths 56846

21^st August: New Cases 69039; new deaths 953, Total cases 2973368, total deaths 55928

20^th August: Cases 68507, 981 deaths, 2904329 total cases, 54975 total deaths

19^th August: Cases 69196, 980 deaths, 2835822 total cases, 53994 total deaths

18^th August: cases 65022, 1089 deaths, 2766626 total cases, 65022 total deaths

17^th August: 54288 cases, 880 deaths, 2701604 total cases, 51925 total deaths

16^th August: 58108 cases, 961 deaths, 2647316 total cases, 51045 deaths

15^th August: 63986 new cases, 950 deaths, 2589208 total cases, 50084 deaths 

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; German: 1: 5; New York City grocery store shoppers: 1: 10; California 1.5%
7. Amongst active 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 /sk km the average number of cases were 2048. On the contrary in states with population density of 909/ sk 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 Corona Viruses (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 ages 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 and millions of copies of itself — which can then be breathed or coughed out to 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 clots are seen in patients even on blood thinners. Netherlands study, 31%
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)
8. Low levels of cross immunity from the other beta-coronaviruses against SARS-CoV-2 could make SARS-CoV-2 appear to die out, only to resurge 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 hydroxy chloroquine with azithromycin or ivermectin with doxycycline with IV ramdesivir 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 ivf very low CD 4 counts).
18. Hypoxia: Low flow oxygen < 6l/mt, titrated to high flow oxygen using non breathing mask, Venti mask, HFNC and helmet CPAP, NAV 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

2. Cases after seven days: Cases today x 2 (based on doubling time 7 days, will change as per doubling time of the country)
3. 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

4. Lock down effect = Reduction in cases after average incubation period (5 days)
5. Lock down effect in reduction in deaths: Reduction in number of deaths on day 14 (average time to death of that country)
6. Requirements of ventilators on day 9: 1-3% of number of new cases detected
7. Requirement of future oxygen on day seven: 10 of total cases detected today
8. Number of people which can be managed at home care: 90% of number of cases today
9. Requirements of ventilators: 1-3% of Number of cases admitted 7-9 days back
10. Requirement of oxygen beds today: 10% of total cases admitted seven days back
11. Case fatality rate: Number of total deaths as on date / number of total RTPCR positive cases as on today
12. Infection fatality rate: Number of total deaths as on date / number of total calculated cases as on today
13. Number of reported deaths = Number of confirmed deaths x 2
14. 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)
15. Number of asymptomatic cases (for 6 symptomatic cases 200 asymptomatic cases)
16. 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