Variants- B 1.1.7 UK, B.1.351South Africa, P1 Brazil

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, 21M August16, 22M August 19, 23M August 21, 24M August 27, 25M August 30, 26M September 3,27M September 7, 28M September 10, 29M September 14, 30M September 18, 31MSeptember 21, 32M September 23, 33M September 28, 34M October 1, 35M October 4,36M October 8, 37M October 11, 38M October 14, 39M October 17, 40M October 19,41M October 22, 42M October 24, 43M October 26, 44M October 28, 45M October 30,46M November 2, 47M November 4, 48M November 6, 49M November 7, 50M November 8,51M November 10, 52M November 12, 53M November 14, 54M November 15, 55MNovember 17, 56M November 19, 57M November 20, 58M November 22, 59M November24, 60M November 25, 61M November 27, 62M November 29, 63M December 1, 64MDecember 2, 65M December 4, 66M December 6, 67M December 7, 68M December 9, 69MDecember 10, 70M December 12, 71M December 13, 72M December 14, 73M December15, 74M December 17, 75M December 19, 76M December 20, 77M December 22, 78MDecember 23, 79M December 26, 80M December 27, 81M December 29, 82M December30, 83M December 31, 84M January 2, 85M January 4, 86M January 6, 87M January7, 88M January 8, 89M January 9, 90M January 10, 91M January 12, 92M January14, 93M January 15, 94M January 17, 95M January 18, 96M January 20, 97M January21, 98M January 23, 99M January 25, 100M January 26, 101M January 29, 102MJanuary 30, 103M February 1, 104M February 4, 105M February 6, 106M February 8,107M February 11, 108M February 13

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

B.1.1.7 lineage (20I/501Y.V1 VOC202012/01): Thisvariant carries a mutation in the receptor binding domain (RBD) of the spikeprotein at position 501; asparagine (N) has been replaced with tyrosine (Y) atthis position. The mutation is also termed as N501Y. This variant also carries othermutations, including -

·                    69/70 deletion:spontaneously occurred several times; possibly results in a conformationalchange in the spike protein;

·                    P681H:spontaneously occurred several times; near the S1/S2 furin cleavage site.

The variant is tied to heightenedtransmissibility (more efficient and rapid transmission). In January this year,scientists from Britain pointed that the B.1.1.7 variant may be linkedwith increased risk of death in comparison with other variants. Early reports donot indicate that the variant affects the severity of disease or vaccineefficacy.

B.1.351 lineage (20H/501Y.V2): This variant carries several mutationsin the spike protein, which include K417N, E484K, N501Y. This variant does not carrythe 69/70 deletion. The variant was first detected in South Africa, in samples asold as from the start of October last year. Cases have been identified outsideof South Africa as well. E484K mutation in this variant may have an impact onneutralization by some polyclonal and monoclonal antibodies.

P.1 lineage (20J/501Y.V3): This variant is a branch off theB.1.1.28 lineage, first identified by the National Institute of InfectiousDiseases (NIID) in Japan among four travelers from Brazil. The samples weretested during routine screening at Haneda airport. This variant has threemutations in the spike protein RBD, including K417T, E484K, and N501Y. Evidenceindicates that some of the mutations in this variant may have an impact on itstransmissibility and antigenic profile, thus affecting the potential of antibodiesproduced by a natural infection or vaccine to identify and neutralize thevirus.

Some consequences of emerging variants:

·                    Potential for quicker spread: D614G mutation increases the ability of the virusto spread more quickly compared to the wild-type virus. Laboratoryexperiments have shown that 614G variants propagate more quickly in humanrespiratory epithelial cells, and outperform the 614D viruses. Data alsosuggest that the 614G variant spreads more quickly than viruses without themutation.

·                    Potential to cause milder or more severe disease in people: The B.1.1.7 variant may be tied to aheightened risk of death compared to other variants.

·                    Potential to evade detection by viral diagnostic tests: B.1.1.7 has Sgene target failure

·                    Diminished susceptibility to therapeutic agents like monoclonalantibodies: B.1.1.28

·                    Potential to evade natural or vaccine-induced immunity: B.1.1.28

Once a large population receives vaccination,immune pressure would likely facilitate and speed up the emergence of suchvariants by selecting for escape mutants.

[CDC] 

Coronavirus Cases: 109,669,084

Deaths: 2,418,205

Recovered: 84,201,002

ACTIVE CASES 22,897,275

Currently Infected Patients 22,952,181 (99.6%) in Mild Condition

97,696 (0.4%) Serious or Critical

CLOSED CASES 86,771,809

Cases which had an outcome: 84,201,002 (97%)

Recovered / Discharged 2,418,205 (3%)

Deaths 

 (Source: https://www.worldometers.info/coronavirus/)

India

15^th February: Newcases 9139, New Deaths 76, Total Cases 10925311, Total Deaths 155840, ActiveCases 138579

14^th February: NewCases 11434, New Deaths 91, Total Cases 10916172, Total Deaths 155764, ActiveCases 141325

13^th February: NewCases 12188, New Deaths 85, Total Cases 10904738, Total Deaths 155673, ActiveCases 139277

12^th February: NewCases 12137, New Deaths 104, Total Cases 10892550, Total Deaths 155588, ActiveCases 138253

11^th February: NewCases 9353, New Deaths 85, Total Cases 10880413, Total Deaths 155484, ActiveCases 137578

10^th February: NewCases 12760, New Deaths 119, Total Cases 10871060, Total Deaths 155399, ActiveCases 144032

9^th February: New Cases10510, New Deaths 85, Total Cases 10858300, Total Deaths 155280, Active Cases143416

8^th February: New Cases8947, New Deaths 81, Total Cases 10847790, Total Deaths 155195, Active Cases145690

7^th February: New Cases11673, New Deaths 86, Total Cases 10838843, Total Deaths 155114, Active Cases150653

6^th February: New Cases11948, New Deaths 72, Total Cases 10827170, Total Deaths 155028, Active Cases150733

5^th February: New cases11689, New Deaths 94, Total Cases 10815222, Total Deaths 154956, Active Cases150476

4^th February: New Cases12410, New Deaths 120, Total Cases 10803533, Total Deaths 154862, Active Cases153270

3^rd February: New Cases12917, New Deaths 107, Total Cases 10791123, Total Deaths 154742, Active Cases156873

2^nd February: New Cases11000, New Deaths 113, Total Cases 10778206, Total Deaths 154635, Active Cases161865

1^st February: New Cases8587, New Deaths 94, Total Cases 10767206, Total Deaths 154522, Active Cases165234

31^st January: New Cases11528, New Deaths 116, Total Cases 10758619, Total Deaths 152428, Active Cases170203

30^th January: New Cases13065, New Deaths 128, Total cases 10747091, Total Deaths 154312, Active Cases170670

29^th January: New cases13055, New deaths 137, Total Cases 10734026, Total Deaths 154184, Active cases171968

28^th January: New Cases18940, New Deaths 162, Total Cases 10720971, Total Deaths 154047, Active Cases173762

27^th January: New Cases11752, New Deaths 134, Total Cases 10702031, Total Deaths 153885, Active Cases175328

26^th January: New Cases12569, New Deaths 127, Total Cases 10690279, Total Deaths 153751, Active Cases178200

25^th January:  NewCases 9036, New Deaths 116, Total Cases 10677710, Total Deaths 153624, ActiveCases 178808

24^th January: New Cases 13239,New deaths 132, Total Cases 10668674, Total Deaths 153508, Active Cases 185992

23^rd January: New cases14891, New deaths 155, Total Cases 10655435, Total Deaths 153376, Active Cases185963

22^nd January: New Cases14344, New Deaths 154, Total Cases 10640544, Total Deaths 153221, Active Cases187260

21^st January: New cases 14481,New Deaths 161, Total Cases 10626200, Total Deaths 153067, Active Cases 190976

20^th January: New Cases15277, New Deaths 152, Total Cases 10611719, Total Deaths 152906, Active Cases193650

19^th January: New Cases 13795,New Deaths 161, Total Cases 10596442, Total Deaths 152754, Active Cases 198596

18^th January: New Cases9975, New Deaths 137, Total Cases 10582647, Total Deaths 152593, Active Cases202202

17^th January: New Cases13962, New Deaths 145, Total Cases 10572672, Total Deaths 152456, Active Cases209519

16^th January: New Cases15051, New Deaths 181, Total Cases 10558710, Total Deaths 152311, Active Cases210215

15^th January: New cases15151, New Deaths 176, Total Cases 10543659, Total Deaths 152130, Active Cases212646

14^th January: New Cases 15677, New Deaths 189, Total Cases 10528508, TotalDeaths 151954, Active Cases 214472

13^th January: New Cases17015, New Deaths 201, Total cases 10512831, Total Deaths 151765, Active Cases214812

12^th January: New cases15903, New Deaths 200, Total Cases 10495816,Total Deaths 151564, Active Cases 217839

11^th January: New cases 12482, New Deaths166, Total Cases 10479913, Total Deaths 151364, Active Cases 217881

10^th January: New cases16085, New Deaths 150, Total cases 10467431, Total Deaths 151198, Active Cases224103

9^th January: New Cases18820, New Deaths 213, Total Cases 10451346, Total Deaths 151048, Active Cases224903

8^th January: New cases18482, New deaths 229, Total Cases 10432526, Total Deaths 150835, Active Cases225756

7^th January: New cases18106, New Deaths 234, Total Cases 10414044, Total Deaths 150606, Active Cases226716

6^th January: New Cases20460, New Deaths 221, Total Cases 10395938, Total Deaths 150372, Active Cases229403

5^th January: New cases 17909, New Deaths 265, Total Cases 10375478, TotalDeaths 150151, Active Cases 228833

4^th January: New Cases16278, New Deaths 200, Total Cases 10357569, Total Deaths 149886, Active Cases232343

3^rd January: New Cases16660, New Deaths 215, Total Cases 10341291, Total Deaths 149686, Active Cases245474

2^nd January: New Cases21222, New Deaths 266, Total Cases 10324631, Total Deaths 149471, ActiveCases 248633

1^st January: New Cases 17080, New Deaths 187, TotalCases 10303409, Total Deaths 149205, Active Cases 252275

31^st December:New Cases 19046, New deaths 244, Total Cases 10286329, Total Deaths 149018,Active Cases 255525

30^th December:New cases 21957, New deaths 299, Total Cases 10267283, Total Deaths 148774,Active Cases 258747

29^th December:New cases 20529, New Deaths 285, Total Cases 10245326, Total Deaths 148475,Active Cases 263512

28^th December:New Cases 16072, New Deaths 250, Total Cases 10224797,  Total Deaths148190, Active Cases  269840

27^th December:New Cases 20333, New Deaths 281, Total Cases 10208725, Total Deaths 147940,Active Cases 278840

26^th December: NewCases 18574, New Deaths 280, Total Cases 10188392, Total Deaths 147659, Active Cases279885

25^th December: Newcases 22350, New Deaths 251, Total Cases 10169818, Total Deaths 147379, ActiveCases 283057
24^th December: New Cases 23924, New Deaths 350, Total Cases10147468, Total Deaths 147128, Active Cases 283142

23^rd December: New Cases24236, New Deaths 302, Total Cases 10123544, Total Deaths 146778, Active Cases284705

22^nd December: New Cases 23886, New Deaths 331, Total Cases 10099308, TotalDeaths 146476, Active Cases 290130

21^st December: Newcases 19174, New Deaths 302, Total Cases 10075422, Total Deaths 146145, ActiveCases 293663

20^th December: Newcases 24589, New Deaths 330, Total Cases 10056248, Total Deaths 145843, ActiveCases 305015

19^th December:New Cases 26834, New Deaths 342, Total Cases 10031659, Total Deaths 145513,Active Cases 306465

18^th December:New Cases 26991, New Deaths 342, Total Cases 10004825, Total Deaths 145171, Active Cases 309731

17^th December: Newcases 26762, New deaths 342, Total Cases 9977834, Total Deaths 144829, ActiveCases 312961

16^th December: New Cases 18164, New Deaths357, Total cases 9951072, Total Deaths144487, Active Cases 328922

15^th December: Newcases 26401, New Deaths 384, Total Cases 9932908, Total Deaths 144130, ActiveCases 332985

14^th December: NewCases 21791, New deaths 353, Total Cases 9906507, Total Deaths 143746, ActiveCases 340929

13^th December: New Cases27336, New Deaths 338, Total Cases9884716, Total Deaths 143393, Active Cases  353715

12^th December: NewCases 30354, New deaths 393, Total Cases 9857380, Total Deaths 143055, ActiveCases 357446

11^th December: Newcases 30034, Total cases 9827026, New Deaths 440, Total Deaths 142662, ActiveCases 360572

10^th December: NewCases 34666, New deaths 487, Total Cases 9796992, Total Deaths 142222, ActiveCases 364582

9^th December: New cases26351, New Deaths 337, Total Cases 9762326, Total Deaths 141735, Active Cases376086

8^th December: New Cases32067, New deaths 404, Total cases 9735975, Total Deaths 141398, Active Cases379771

7^th December: New Cases27107, New deaths 404, Total Cases 9703908, Total Deaths 140994, Active Cases385269

6^th December: New Cases32272, New Deaths 374, Total Cases 9676801, Total Deaths 140590,Active Cases 398040

5^th December: New cases36111, New Deaths 480, Total Cases 9644529, Total Deaths 140216, Active Cases404367

4^th December: New Cases36638, New Deaths 509, Total Cases 9608418, Total Deaths 139736, Active Cases410679

3^rd December: New Cases38309, New Deaths 570, Total Cases 9571780, Total Deaths 139227, Active Cases416869

2^nd December: New Cases33761, New Deaths 498, Total Cases 9533471, Total Deaths 138657, Active Cases424710

1^st December: New Cases36456, New deaths 500, Total Cases 9499710, Total Deaths 138159, Active Cases429753

30th November:  New Cases 31179,New Deaths 482, Total cases 9463254, Total Deaths 137659, Active Cases 437000

29^th November: New Cases 39036, New deaths 444, Total Cases 9432075, Total Deaths137177, Active Cases 448585

28^th November:New Cases 41815, New Deaths 495, Total Cases 9393039, Total Deaths 136733, ActiveCases 454837

27^th November: New cases 4135 3, New deaths 486, TotalCases 9351224, Total Deaths 136238, Active Cases 456100

26^th November: NewCases 43174, New Deaths 491, Total cases 9309871, Total Deaths 135752, ActiveCases 456410

25^th November: New Cases 44699, New Deaths 518,Total Cases 9266697, Total Deaths 135261, Active Cases 453450

24^th November: New cases44276, New Deaths 489, Total Cases 9221998, Total Deaths 134743, Active Cases 445851

23^rd November: Newcases 37410, New Deaths  481, Total cases 9177722, Total Deaths 134254,Active Cases 439893

22^nd November: New cases44404, New Deaths 510, Total Cases 9140312, Total Deaths 133773, ActiveCases 445095

21^st November: NewCases 45295, New deaths 499, Total Deaths 9095908, Total Deaths 133263, ActiveCases 442606

20^th November: NewCases 46288, New Deaths 562, Total Cases 9050613, Total Deaths 132764, ActiveCases 441952

19^th November: NewCases 46182, New Deaths 584, Total Cases 9004325, Total Deaths 132202, ActiveCases 445107

18^th November: NewCases 45439, New Deaths 587, Total Cases 8958143, Total Deaths 131618, ActiveCases 444755

17^th November: NewCases 38532, New deaths 472, Total Cases 8912704, Total Deaths 131031, ActiveCases 448660
16^th November: New Cases 28555, New Deaths 450, Total Cases8874172, Total Deaths 130559, Active Cases 455444,

15^th November: Newcases 30715, New Deaths 435, Total Cases 8845617 (8.8. Million), Total Deaths130109, Active Cases 467558

14^th November: NewCases 41659, New Deaths 449, Total Cases 8814902, Total Deaths 129674, ActiveCases 481491

13^th November: Newcases 45343, New Deaths 539, Total Cases 8773243, Total Deaths 129225, ActiveCases 482551

12^th November: NewCases 43861, New Deaths 521, Total Cases 8727900, Total Deaths 128686

11^th November: NewCases 48285, New Deaths 549, Total Cases 10703056, Total Deaths 128164

10^th November: NewCases 44679, New Deaths 511, Total Cases 8635754, Total Deaths 127615

9^th November: New cases37211, New Deaths 451, Total Cases 8591075, Total Deaths 127104, Active Cases506765

8^th November: New Cases46661, New Deaths 491, Total Cases 8553864, Total Deaths 126653, Active Cases511551

7^th November: New Cases46318, New deaths 557, Total cases 8507203, Total Deaths 126162, Active Cases513750

6^th November: New Cases49851, New Deaths 576, Total Cases 8460885, Total Deaths 125605

5^th November: New Cases47622, New Deaths 675, Total Cases 8411034, Total Deaths 125029, Active Cases3335730

4^th November: New Cases50465, New Deaths 704, Total Cases 8363412, Total Deaths 124354, Active Cases528428

3^rd November: New Cases46033, New Deaths 511, Total Cases 8312947, Total Deaths 123650, Active Cases534540

2^nd November: New Cases37592, New Deaths  497, Total Cases 8266914, Total Deaths 123139, ActiveCases 542346

1^st November: New Cases46441, New Deaths 493, Total Cases 8229322, Total Deaths 122642, Active Cases563775

31^st October: New Cases46715, New Deaths 468, Total Cases 8136166, Total Deaths 122149, ActiveCases 571529

30^th October: New Cases48120, New Deaths 550, Total Cases 813666, Total Deaths 121681, Active Cases583574

29^th October: New Cases49281, New Deaths 568, Total Cases 8088046, Total Deaths 121131

28^th October: New cases49912, New Deaths 509, Total cases 8038765, Total Deaths 120563, Active Cases603251

27^th October: New Cases42965, New deaths 519, Total Cases 7988853, Total Deaths 120054, Active Cases611605

26^th October: New Cases36838, New deaths 505, Total Cases 7945888, Total Deaths 119535, Active Cases627638

25^th October: New Cases45158, New Deaths 463, Total Cases 7909050, Total Deaths 119030, Active Cases656026

24^th October: New Cases50224, New Deaths 575, Total Cases 7863892, Total Deaths 118567, Active Cases7075723

23^rd October: New Cases54028, New Deaths 656, Total Cases 7813668, Total Deaths 117992, Active Cases682107

22^nd October: New Cases54482, New Deaths 683, Total Cases 7759640, Total Deaths 117336, Active Cases695979

21^st October: New cases56000, New Deaths 703, Total Cases 7705158, Total Deaths 116653, Active Cases716610

20^th October: New Cases54422, New Deaths 714, Total Cases 7649158, Total Deaths 115950, Active Cases740658

19^th October: New Cases46498, New Death 594, Total Cases 7594736, Total Deaths 115236, Active Cases748883

18^th October: New Cases55511, New Deaths 578, Total Cases 7548238, Total Deaths 114642, Active Cases773701

17^th October: New Cases62092, New deaths 1032, Total Cases 7492727, Total Deaths 114064, Active Cases784264

16^th October: New Cases65126, New Deaths 886, Total Cases 7430635, Total Deaths 113032, Active Cases795969

Indiapredictions

1.      Deathrate is deaths today vs number of cases today.

2.          Corrected death rate is deaths todayvs number of cases 14 days back.

3.          For one symptomatic test positivecase, there are 10-30 asymptomatic cases and 20 untested cases.

4.          Estimated number of deaths = Reporteddeaths x 2.

5.          Number of deaths today should be 15%of the serious patients present 14 days back.

6.          Undocumented cases for each documentedcase - 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

DENSITY:India: In states with average population density of 1185/sq km, the averagenumber of cases were 2048. On the contrary, in states with population densityof 909/sq km, the number of cases were 56. When Chandigarh and Pondicherry weretaken out from this group, the Average Density of other states were 217 and theaverage number of cases were 35. [HCFI] 

COVID Sutra: COVID-19 pandemic is due to SARS 2 Beta-coronavirus (differentfrom SARS 1 where spread was only in serious cases); with over eleven virussequences floating; Causes Mild or Atypical Illness in 82%, Moderate to SevereIllness in 15%, Critical Illness in 3% and Death in 2.3% cases (15% of admittedserious cases, 71% with comorbidity< Male > Females); affects all butPredominantly 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 toSymptoms 5 days;  Mean Time to Pneumonia 9 days, Mean Time to Death 14days,  Mean Time to CT changes 4 Days, Reproductive Number R0 1.5 to3  (Flu 1.2 and SARS 2), Epidemic Doubling Time 7.5 days; Origin Possiblyfrom Bats (Mammal); Spreads via Human to Human Transmission via Large and SmallDroplets and Surface to Human Transmission via Viruses on Surfaces for up tothree days. Enters through MM of eyes, nose or mouth and the spike protein getsattached to the ACE2 receptors. ACE2 receptors make a great target becausethey 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 andinfect others.

The most important

1.    Masking is THE prevention

2.    RT PCR Ct is THE test for diagnosis

3.    Zinc is THE Vitamin

4.    Day 5 is THE dayin COVID phase for mortality prevention

5.    Day 90 is THE day after which the word COVID ends

6.    Home Isolation is THE modality ofTreatment

7.    12 years is THE age when themortality starts

8.    CRP is THE lab test for seriousness

9.    Loss of Smell is THE symptom equal toRT PCR test

10. 15 minutes is THE time to get theinfection.

Numbers to remember

1.    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770945: RDW at admission 14.5%

Other Sutras

1.      Viralparticles are seen in tears, stool, kidneys, liver, pancreas, heart, semen,peritoneal fluid, CSF.

2.      Thrombosis:University of Pennsylvania has reported that clots are seen in patients evenon blood thinners.

3.      Otherhuman beta-coronaviruses have immunity lasting only for one year with noIMMUNITY PASSPORT.

4.      Inabsence of interventions, prolonged or intermittent social distancing (till2022-24) is the key.

5.      Dueto low levels of cross immunity from other beta-coronaviruses againstSARS-CoV-2, the virus may appear to fade away, only to show resurgence after afew years. Surveillance till 2024.

6.      Duringpeak, trace and treat, and after the peak, trace and treat the close contacts.

7.      Increasedspread: Close environment, crowded place with close physical contacts with noventilation.

8.      Strategies:From community mitigation to individual containment; broader good overindividual autonomy; perfect cannot be the enemy of the good; pandemics arefought on the grounds and not the hospitals. Treat the patient and not the testreport; consider every surface and every asymptomatic person as virus carrier.

9.  HCW:Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.

10.  Italy:mortality reduced when they were short of ventilators.

11.  Hospitalat HOME: CHF, mild pneumonia, exacerbations of asthma and COPD,cellulitis, and urinary tract infections.

12.  GreatImitator (protean manifestation).

13.  IgMcan be false positive in pregnancy, immunological diseases; Pooled tests(<5, 20 Kerala, 64 Singapore RT PCR) when seroprevalence is <2%.

14.  Earlytreatment, day 3-5, to reduce the viral load and prevent cytokine storm usinghydroxychloroquine with azithromycin or ivermectin with doxycycline with IVremdesivir and IV single dose tocilizumab (IL-6 receptor inhibitor) if veryhigh D-dimer and IL-6; convalescent plasma therapy (given early; donor 14 dayssymptoms free, between day 28-40, single donation can help 4 patients),Lopinavir-ritonavir and Favipiravir if very low CD 4 counts.

15.  Hypoxia: Low flow oxygen <6l/mt,titrated to high flow oxygen using non rebreathing mask, Venturi mask, HFNC andhelmet CPAP, NIV in supine or prone position.

16.  Earlyintubation with prone ventilation only if progressive. Hypoxia (walking dead)have capillary problem and not alveoli.

Formulas and Predictions

Deaths

1.     Thegoal is to save lives. Monitoring deaths is important, especially when testingis limited.

2.     Dailydeaths are the best indicator of the progression of the pandemic, althoughthere is generally a 17- to 21-day lag between infection and deaths.

3.     Deathsin symptomatic cases: Less than one percent (best of the care).

4.     Therefore,Deaths X 100 = expected number of symptomatic cases

5.     Some may count probable orpresumptive COVID-19 deaths when cases are not confirmed with a positive testbut on the basis of symptoms and medical history. In New York, 3,700presumptive deaths were added in one day in April when testing was limited.

6.     Casefatality rate: Number of total deaths as on date/number of total RTPCR positivecases as on today

7.     Infectionfatality rate: Number of total deaths as on date/number of total calculatedcases as on today

8.     Numberof reported deaths: Number of confirmed deaths x 2

Prediction Metrics

1.     TheUniversity of Washingtons Institute for Health Metrics and Evaluation (IHME):

Is based on what is known about adisease and how peoples actions may affect that.

Forecastsare not fixed but change depending on public behavior. When people learn thatnew cases are rising, they start wearing masks and using social distancingagain; and when they realize that fresh cases are dropping, they tend to droptheir guard.  IHME makes use of real-timeinfection data from Johns Hopkins Universitys Coronavirus Resource Center torepresent disease transmission and estimate how many Americans will die. Theresearchers then estimate how many Americans are wearing masks or using socialdistancing, which can modulate the final model.

Therate of infection in a population is based on the "R0," orreproduction number. R0 represents the average number of people who willcontract the infection from a single infected person, in a population thatsnever been witness to the disease before. If R0 is 3, it suggests that one casewill create an average of three new cases. When that transmission rate ofinfection occurs at a specific time, its called an "effective R," or"Rt."  R0 less than 1 means theepidemic is under control; and when its higher than 1, it is still spreading.

IHMEfound the "effective R over 1 in Oklahoma. In all other states theeffective R was found to be less than 1.”

2.     CDC: Relies on positive tests results.CDCs report these as confirmed cases. The positivity rate suggests how tough oreasy it is to find a case, which is an indicator of both the spread of COVID-19and how widespread testing is. If the rate of positive tests is 20%, onedoesn’t have to look hard to find a case, compared to 1%, which means that onehas to do a lot of tests to get a positive one. The more COVID-19 spreads, thehigher the positivity rate. A 60% positivity rate may suggest that testing isonly being done in a nursing home during an outbreak or a hospital where themost apparent cases are and not the general population where cases may bemilder.

3.     Marylands COVID-19 dashboard: It reportsthe daily positivity percentage (percentage of positive tests and total testingvolume since March). While looking at testing, one wants to know how many testswere done historically with the ability to compare and understand if the numberhas increased or declined or is stable and the percentage that is positive.Maryland and Pennsylvania report a 7-day rolling average of the dailypositivity percentages. The 7-day average rate better indicates a trend ascompared to daily numbers.

4.      The testing numbers often fluctuate,depending on where testing is done and when the labs report test results. Asudden surge in testing numbers may point to a large number of tests done in agroup setting such as a nursing home or prison on a single day. Laboratoriesand hospitals report test results on weekdays, so the numbers can decline onweekends.

5.     A major goal during the coronavirusepidemic has been to flatten the curve to maintain local hospital capacity.After expected COVID-19 surges, many hospitals limited surgeries and admissionsto preserve their resources, including hospital beds, ventilators, andhealthcare personnel.  [WebMD]

Infrastructure Capacity

1.     If hospital capacity reaches 80%, we mayhave to stop admitting patients to prevent the hospital from being overwhelmed.

2.     Inorder to plan for surges and increase capacity: It is required to know thenumber of people who tested positive and were admitted to the hospital withsymptoms of COVID-19.

3.    Pennsylvanias COVID-19 dashboard: has a hospital preparedness page that shows the number of hospitalizedCOVID-19 patients and the number and percentage of available beds by unit,including intensive care, medical/surgical, and airborne isolation.

4.     Pennsylvania: Reports the number of ventilators COVID-19 patients andnon-COVID-19 patients use every day.

5.     Illinoislists the recovery rate: In Illinois, the recovery rate of 95% is calculated asrecovered cases divided by recovered cases plus confirmed deaths. Thisindicates the quality of medical care and the severity of disease.[WebMD]

6.     Caseswill double after the average doubling time of the country at that time

7.     Cases expected in the community: Get number of deaths occurring in afive-day period

Estimate the number of infectionsrequired to generate these deaths based on the country or area case fatalityrate

Compare that to the number of newcases actually detected in the five-day period.

This can then give us an estimate ofthe total number of cases, confirmed and unconfirmed

8.     Lock down effect: Reduction in cases after average incubation period (5days)

 9.     Lock down effect in reduction in deaths: Reduction in number of deathson day 14 (average time to death of that country)

10.  Requirementof ventilators on day 9: 1-3% of number of new cases detected

11. Requirementof future oxygen on day 7: 10% of total cases detected today

12. Numberof people which can be managed at home care: 90% of number of cases today

13. Requirementof ventilators: 1-3% of number of cases admitted 7-9 days back

14. Requirementof oxygen beds today: 10% of total cases admitted seven days back

15. Numberof unreported or untested cases: Number of reported cases x 10-30 (depending onthe country, New York 10, Delhi 23.8, Pakistan 30)

16. Numberof asymptomatic cases: For 6 symptomatic cases, 200 asymptomatic cases (CHINA);(1.78 M tests in Hong Kong, 32 asymptomatic cases, 10 symptomatic cases)

17.  Oxygenrequirement on that day in the hospital at 6am: Number of cases detected tohave hypoxia on six minutes walk test.

Dr KK Aggarwal

President CMAAO, HCFI and Past NationalPresident IMA