Cases:1M April 2, 2M April 15, 3M April 27, 4M May 8, 5M May 20, 6M May 30, 7M June7, 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 August 16, 22M August 19, 23M August 21, 24M August 27, 25MAugust 30, 26M September 3, 27M September 7, 28M September 10, 29M September14, 30M September 18, 31M September 21, 32M September 23, 33M September 28, 34MOctober 1, 35M October 4, 36M October 8, 37M October 11, 38M October 14, 39MOctober 17, 40M October 19, 41M October 22, 42M October 24, 43M October 26, 44MOctober 28, 45M October 30, 46M November 2, 47M November 4, 48M November 6, 49MNovember 7, 50M November 8, 51M November 10, 52M November 12, 53M November 14,54M November 15, 55M November 17, 56M November 19, 57M November 20, 58MNovember 22, 59M November 24, 60M November 25, 61M November 27, 62M November29, 63M December 1, 64M December 2, 65M December 4, 66M December 6, 67M December7, 68M December 9, 69M December 10, 70M December 12, 71M December 13, 72MDecember 14, 73M December 15, 74M December 17, 75M December 19, 76M December20, 77M December 22, 78M December 23, 79M December 26, 80M December 27, 81MDecember 29, 82M December 30, 83M December 31, 84M January 2, 85M January 4,86M January 6, 87M January 7, 88M January 8, 89M January 9, 90M January 10, 91MJanuary 12, 92M January 14, 93M January 15, 94M January 17, 95M January 18, 96MJanuary 20, 97M January 21, 98M January 23, 99M January 25, 100M January 26,101M January 29, 102M January 30, 103M February 1, 104M February 4, 105MFebruary 6, 106M February 8, 107M February 11, 108M February 13, 109M February16, 110M February 18, 111M February 21, 112M February 24, 113M February 28,114M March 1, 115M March 4, 116M March 6, 117M March 9

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

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

B.1.1.7 lineage (20I/501Y.V1 VOC 202012/01): 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 carriesother mutations, including -

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

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

The variant is tied to heightened transmissibility (moreefficient and rapid transmission). In January this year, scientists fromBritain pointed that the B.1.1.7 variant may be linked with increased riskof death in comparison with other variants. Early reports do not indicate thatthe variant affects the severity of disease or vaccine efficacy.

B.1.351 lineage (20H/501Y.V2): Thisvariant carries several mutations in the spike protein, which include K417N,E484K, N501Y. This variant does not carry the 69/70 deletion. The variant wasfirst detected in South Africa, in samples as old as from the start of Octoberlast year. Cases have been identified outside of South Africa as well. E484Kmutation in this variant may have an impact on neutralization by somepolyclonal and monoclonal antibodies.

P.1 lineage (20J/501Y.V3): Thisvariant is a branch off the B.1.1.28 lineage, first identified by the NationalInstitute of Infectious Diseases (NIID) in Japan among four travelers fromBrazil. The samples were tested during routine screening at Haneda airport.This variant has three mutations in the spike protein RBD, including K417T,E484K, and N501Y. Evidence indicates that some of the mutations in this variantmay have an impact on its transmissibility and antigenic profile, thusaffecting the potential of antibodies produced by a natural infection orvaccine to identify and neutralize the virus.

Some consequences of emerging variants:

·         Potentialfor quicker spread: D614G mutation increases the abilityof the virus to spread more quickly compared to the wild-type virus.Laboratory experiments have shown that 614G variants propagate more quickly inhuman respiratory epithelial cells, and outperform the 614D viruses. Data alsosuggest that the 614G variant spreads more quickly than viruses without themutation.

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

·         Potentialto evade detection by viral diagnostic tests: B.1.1.7has S gene target failure

·         Diminishedsusceptibility to therapeutic agents like monoclonal antibodies: B.1.1.28

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

Once a large population receives vaccination, immunepressure would likely facilitate and speed up the emergence of such variants byselecting for escape mutants.

[CDC]

Coronavirus Cases:

118,618,041

Deaths:

2,631,094

Recovered:

94,229,908

ACTIVE CASES

21,757,039

Currently Infected Patients

21,667,204 (99.6%)

in Mild Condition

89,835 (0.4%)

Serious or Critical

CLOSED CASES

96,861,002

Cases which had an outcome:94,229,908 (97%) Recovered / Discharged

2,631,094 (3%)

Deaths

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

India

10^th March: New Cases22841, New Deaths 134, Total Cases 11284311, Total Deaths 158213, Active Cases190295

9^th March: New Cases16846, New Deaths 113, Total cases 11261470, Total Deaths 158079, Active Cases185767

8^th March: New Cases15353, New Deaths 76, Total Cases 11244624, Total Deaths 157966, Active Cases189172

7^th March: New Cases18691, New Deaths 99, Total Cases 11229271, Total Deaths 157890, Active Cases190501

6^th March: New Cases18716, New Deaths 98, Total Cases 11210580, Total Deaths 157791, Active Cases186253

5th March: New Cases 18292, NewDeaths 109, Total Cases 11191864, Total Deaths 157693, Active Cases 181997

4^th March: New Cases16824, New Deaths 113, Total Cases 11173572, Total Deaths 157584, Active Cases177967

3^rd March: New Cases17425, New Deaths 86, Total Cases 11156748, Total Deaths 157471, Active Cases175044

2^nd March: New Cases15704, New Deaths 110, Total Cases 11139323, Total Deaths 157385, Active Cases171776

1^st March: New Cases 11563, New Deaths 80, Total Cases 11123619,Total Deaths 157275, Active Cases 169786

28^th February: NewCases 15616, New Deaths 108, Total Cases 11112056, Total Deaths 157195, ActiveCases 170293

27^th February: NewCases 17346, New Deaths 117, Total Cases 11096440, Total Deaths 157087, ActiveCases 166079

26^th February: Newcases 16056, New Deaths 109, Total Cases 11079094, Total Deaths 156970, ActiveCases 160985

25^th February: NewCases 16568, New deaths 119, Total Cases 11063038, Total Deaths 156861, ActiveCases 157418

24^th February: NewCases 17144, New Deaths 144, Total Cases 11046470, Total Deaths 156742, ActiveCases 153257

23^rd February: NewCases 13463, New Deaths 100, Total Cases 11029326, Total Deaths 156598, ActiveCases 148584

22^nd February: NewCases 10792, New Deaths 80, Total Cases 11015863, Total Deaths 156498, ActiveCases 148882

21^st February: NewCases 13980, New Deaths 79, Total Cases 11005071, Total Deaths 156418, ActiveCases 151639

20^th February: NewCases 14315, New Deaths 99, Total Cases 10991091, Total Deaths 156339, ActiveCases 147214

19^th February: NewCases 14587, New Deaths 117, Total Cases 10976776, Total Deaths 156240,

18^th February: Newcases 12643, New Deaths 85, Total Cases 10962189, Total Deaths 156123, ActiveCases 140998

17^th February: New Cases12440, New Deaths 89, Total Cases 10949546, Total Deaths 156038, Active Cases138802

16^th February: NewCases 11795, New Deaths 109, Total Cases 10937106, Total Deaths 155949, ActiveCases 138254

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: NewCases 10510, New Deaths 85, Total Cases 10858300, Total Deaths 155280, ActiveCases 143416

8^th February: NewCases 8947, New Deaths 81, Total Cases 10847790, Total Deaths 155195, ActiveCases 145690

7^th February: NewCases 11673, New Deaths 86, Total Cases 10838843, Total Deaths 155114, ActiveCases 150653

6^th February: NewCases 11948, New Deaths 72, Total Cases 10827170, Total Deaths 155028, ActiveCases 150733

5^th February: Newcases 11689, New Deaths 94, Total Cases 10815222, Total Deaths 154956, ActiveCases 150476

4^th February: NewCases 12410, New Deaths 120, Total Cases 10803533, Total Deaths 154862, ActiveCases 153270

3^rd February: NewCases 12917, New Deaths 107, Total Cases 10791123, Total Deaths 154742, ActiveCases 156873

2^nd February: NewCases 11000, New Deaths 113, Total Cases 10778206, Total Deaths 154635, ActiveCases 161865

1^st February: NewCases 8587, New Deaths 94, Total Cases 10767206, Total Deaths 154522, ActiveCases 165234

31^st January: NewCases 11528, New Deaths 116, Total Cases 10758619, Total Deaths 152428, ActiveCases 170203

30^th January: New Cases 13065, New Deaths 128,Total cases 10747091, Total Deaths 154312, Active Cases 170670

29^th January: Newcases 13055, New deaths 137, Total Cases 10734026, Total Deaths 154184, Activecases 171968

28^th January: NewCases 18940, New Deaths 162, Total Cases 10720971, Total Deaths 154047, ActiveCases 173762

27^th January: NewCases 11752, New Deaths 134, Total Cases 10702031, Total Deaths 153885, ActiveCases 175328

26^th January: NewCases 12569, New Deaths 127, Total Cases 10690279, Total Deaths 153751, ActiveCases 178200

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

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

23^rd January: Newcases 14891, New deaths 155, Total Cases 10655435, Total Deaths 153376, ActiveCases 185963

22^nd January: NewCases 14344, New Deaths 154, Total Cases 10640544, Total Deaths 153221, ActiveCases 187260

21^st January: Newcases 14481, New Deaths 161, Total Cases 10626200, Total Deaths 153067, ActiveCases 190976

20^th January: NewCases 15277, New Deaths 152, Total Cases 10611719, Total Deaths 152906, ActiveCases 193650

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

18^th January: NewCases 9975, New Deaths 137, Total Cases 10582647, Total Deaths 152593, ActiveCases 202202

17^th January: NewCases 13962, New Deaths 145, Total Cases 10572672, Total Deaths 152456, ActiveCases 209519

16^th January: NewCases 15051, New Deaths 181, Total Cases 10558710, Total Deaths 152311, ActiveCases 210215

15^th January: Newcases 15151, New Deaths 176, Total Cases 10543659, Total Deaths 152130, ActiveCases 212646

14^th January: NewCases 15677, New Deaths 189, Total Cases 10528508, Total Deaths151954, Active Cases 214472

13^th January: NewCases 17015, New Deaths 201, Total cases 10512831, Total Deaths 151765, ActiveCases 214812

12^th January: Newcases 15903, New Deaths 200, Total Cases 10495816, TotalDeaths 151564, Active Cases 217839

11^th January: Newcases 12482, New Deaths 166, Total Cases 10479913, Total Deaths151364, Active Cases 217881

10^th January: Newcases 16085, New Deaths 150, Total cases 10467431, Total Deaths 151198, ActiveCases 224103

9^th January: NewCases 18820, New Deaths 213, Total Cases 10451346, Total Deaths 151048, ActiveCases 224903

8^th January: Newcases 18482, New deaths 229, Total Cases 10432526, Total Deaths 150835, ActiveCases 225756

7^th January: Newcases 18106, New Deaths 234, Total Cases 10414044, Total Deaths 150606, ActiveCases 226716

6^th January: NewCases 20460, New Deaths 221, Total Cases 10395938, Total Deaths 150372, ActiveCases 229403

5^th January: Newcases 17909, New Deaths 265, Total Cases 10375478, Total Deaths150151, Active Cases 228833

4^th January: NewCases 16278, New Deaths 200, Total Cases 10357569, Total Deaths 149886, ActiveCases 232343

3^rd January: NewCases 16660, New Deaths 215, Total Cases 10341291, Total Deaths 149686, ActiveCases 245474

2^nd January: NewCases 21222, New Deaths 266, Total Cases 10324631, TotalDeaths 149471, Active Cases 248633

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

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

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

29^th December: Newcases 20529, New Deaths 285, Total Cases 10245326, Total Deaths 148475, ActiveCases 263512

28^th December: NewCases 16072, New Deaths 250, Total Cases 10224797,  Total Deaths 148190,Active Cases  269840

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

26^th December: NewCases 18574, New Deaths 280, Total Cases 10188392, Total Deaths 147659, ActiveCases 279885

25^th December: Newcases 22350, New Deaths 251, Total Cases 10169818, Total Deaths 147379, ActiveCases 283057

24^th December: NewCases 23924, New Deaths 350, Total Cases 10147468, Total Deaths 147128, ActiveCases 283142

23^rd December: NewCases 24236, New Deaths 302, Total Cases 10123544, Total Deaths 146778, ActiveCases 284705

22^nd December: NewCases 23886, New Deaths 331, Total Cases 10099308, Total Deaths146476, 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: NewCases 26834, New Deaths 342, Total Cases 10031659, Total Deaths 145513, ActiveCases 306465

18^th December: New Cases 26991, NewDeaths 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: NewCases 18164, New Deaths 357, 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: NewCases 27336, New Deaths 338, Total Cases 9884716, 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: Newcases 26351, New Deaths 337, Total Cases 9762326, Total Deaths 141735, ActiveCases 376086

8^th December: NewCases 32067, New deaths 404, Total cases 9735975, Total Deaths 141398, ActiveCases 379771

7^th December: NewCases 27107, New deaths 404, Total Cases 9703908, Total Deaths 140994, ActiveCases 385269

6^th December: NewCases 32272, New Deaths 374, Total Cases 9676801, Total Deaths 140590,Active Cases 398040

5^th December: Newcases 36111, New Deaths 480, Total Cases 9644529, Total Deaths 140216, ActiveCases 404367

4^th December: NewCases 36638, New Deaths 509, Total Cases 9608418, Total Deaths 139736, ActiveCases 410679

3^rd December: NewCases 38309, New Deaths 570, Total Cases 9571780, Total Deaths 139227, ActiveCases 416869

2^nd December: NewCases 33761, New Deaths 498, Total Cases 9533471, Total Deaths 138657, ActiveCases 424710

1^st December: NewCases 36456, New deaths 500, Total Cases 9499710, Total Deaths 138159, ActiveCases 429753

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

29^th November: NewCases 39036, New deaths 444, Total Cases 9432075, Total Deaths 137177, ActiveCases 448585

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

27^th November: New cases 4135 3, New deaths486, Total Cases 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, NewDeaths 518, Total Cases 9266697, Total Deaths 135261, Active Cases 453450

24^th November: Newcases 44276, 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: Newcases 44404, New Deaths 510, Total Cases 9140312, Total Deaths 133773,Active Cases 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: NewCases 28555, New Deaths 450, Total Cases 8874172, Total Deaths 130559, ActiveCases 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: Newcases 37211, New Deaths 451, Total Cases 8591075, Total Deaths 127104, ActiveCases 506765

8^th November: NewCases 46661, New Deaths 491, Total Cases 8553864, Total Deaths 126653, ActiveCases 511551

7^th November: NewCases 46318, New deaths 557, Total cases 8507203, Total Deaths 126162, ActiveCases 513750

6^th November: NewCases 49851, New Deaths 576, Total Cases 8460885, Total Deaths 125605

5^th November: NewCases 47622, New Deaths 675, Total Cases 8411034, Total Deaths 125029, ActiveCases 3335730

4^th November: NewCases 50465, New Deaths 704, Total Cases 8363412, Total Deaths 124354, ActiveCases 528428

3^rd November: NewCases 46033, New Deaths 511, Total Cases 8312947, Total Deaths 123650, ActiveCases 534540

2^nd November: NewCases 37592, New Deaths  497, Total Cases 8266914, Total Deaths 123139,Active Cases 542346

1^st November: NewCases 46441, New Deaths 493, Total Cases 8229322, Total Deaths 122642, ActiveCases 563775

31^st October: NewCases 46715, New Deaths 468, Total Cases 8136166, Total Deaths 122149,Active Cases 571529

30^th October: NewCases 48120, New Deaths 550, Total Cases 813666, Total Deaths 121681, ActiveCases 583574

29^th October: NewCases 49281, New Deaths 568, Total Cases 8088046, Total Deaths 121131

28^th October: Newcases 49912, New Deaths 509, Total cases 8038765, Total Deaths 120563, ActiveCases 603251

27^th October: NewCases 42965, New deaths 519, Total Cases 7988853, Total Deaths 120054, ActiveCases 611605

26^th October: NewCases 36838, New deaths 505, Total Cases 7945888, Total Deaths 119535, ActiveCases 627638

25^th October: NewCases 45158, New Deaths 463, Total Cases 7909050, Total Deaths 119030, ActiveCases 656026

24^th October: NewCases 50224, New Deaths 575, Total Cases 7863892, Total Deaths 118567, ActiveCases 7075723

23^rd October: NewCases 54028, New Deaths 656, Total Cases 7813668, Total Deaths 117992, ActiveCases 682107

22^nd October: NewCases 54482, New Deaths 683, Total Cases 7759640, Total Deaths 117336, ActiveCases 695979

21^st October: Newcases 56000, New Deaths 703, Total Cases 7705158, Total Deaths 116653, ActiveCases 716610

20^th October: NewCases 54422, New Deaths 714, Total Cases 7649158, Total Deaths 115950, ActiveCases 740658

19^th October: NewCases 46498, New Death 594, Total Cases 7594736, Total Deaths 115236, ActiveCases 748883

18^th October: NewCases 55511, New Deaths 578, Total Cases 7548238, Total Deaths 114642, ActiveCases 773701

17^th October: NewCases 62092, New deaths 1032, Total Cases 7492727, Total Deaths 114064, ActiveCases 784264

16^th October: NewCases 65126, New Deaths 886, Total Cases 7430635, Total Deaths 113032, ActiveCases 795969

India predictions

1.    Deathrate 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 and20 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 daysback.

6. Amongst active cases, 2.37% areserious, 1.82% need oxygen, and 0.41% need ventilator support.

Facts

DENSITY: India: In states withaverage population density of 1185/sq km, the average number of cases were2048. On the contrary, in states with population density of 909/sq km, thenumber of cases were 56. When Chandigarh and Pondicherry were taken out fromthis group, the Average Density of other states were 217 and the average numberof cases were 35. [HCFI]

COVID Sutra: COVID-19pandemic is due to SARS 2 Beta-coronavirus (different from SARS 1 where spreadwas only in serious cases); with over eleven virus sequences floating; CausesMild or Atypical Illness in 82%, Moderate to Severe Illness in 15%, CriticalIllness in 3% and Death in 2.3% cases (15% of admitted serious cases, 71% withcomorbidity< Male > Females); affects all ages but Predominantly Males(56%, 87% aged 30-79, 10% Aged < 20, 3% aged > 80); with VariableIncubation Period days (2-14; mean 5.2 days);  Mean Time to Symptoms 5days;  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 1.2and SARS 2), Epidemic Doubling Time 7.5 days; Origin Possibly from Bats(Mammal); Spreads via Human to Human Transmission via Large and Small Dropletsand 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 tothe ACE2 receptors. ACE2 receptors make a great target because they arefound in organs throughout our bodies (heart muscle, CNS, kidneys, bloodvessels, 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.    Maskingis THE prevention

2.    RTPCR Ct is THE test for diagnosis

3.    Zincis 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.    HomeIsolation is THE modality of Treatment

7.    12years is THE age when the mortality starts

8.    CRPis THE lab test for seriousness

9.    Lossof Smell is THE symptom equal to RT PCR test

10. 15 minutes is THE time toget the infection.

Numbers to remember

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

Other Sutras

1.      Viral particles areseen 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.      Other humanbeta-coronaviruses have immunity lasting only for one year with no IMMUNITYPASSPORT.

4.      In absence ofinterventions, prolonged or intermittent social distancing (till 2022-24) isthe key.

5.      Due to low levels ofcross immunity from other beta-coronaviruses against SARS-CoV-2, the virus mayappear to fade away, only to show resurgence after a few years. Surveillancetill 2024.

6.      During peak, traceand treat, and after the peak, trace and treat the close contacts.

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

8.      Strategies: Fromcommunity mitigation to individual containment; broader good over individualautonomy; perfect cannot be the enemy of the good; pandemics are fought on thegrounds and not the hospitals. Treat the patient and not the test report;consider every surface and every asymptomatic person as virus carrier.

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

10.  Italy: mortality reduced when they wereshort of ventilators.

11.  Hospital at HOME: CHF, mildpneumonia, exacerbations of asthma and COPD, cellulitis, and urinary tractinfections.

12.  Great Imitator (protean manifestation).

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

14.  Early treatment, day 3-5, to reduce theviral load and prevent cytokine storm.

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

16.  Early intubation withprone ventilation only if progressive. Hypoxia (walking dead) have capillaryproblem and not alveoli.

Formulas andPredictions

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.     Somemay count probable or presumptive COVID-19 deaths when cases are not confirmedwith a positive test but on the basis of symptoms and medical history. In NewYork, 3,700 presumptive deaths were added in one day in April when testing waslimited.

6.     Casefatality rate: Number of total deaths as on date/number of total RT PCRpositive cases 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.     The University of WashingtonsInstitute for Health Metrics and Evaluation (IHME):

Is based on what is known about a disease and how peoples actionsmay affect that.

Forecasts are not fixed but change depending on publicbehavior. When people learn that new cases are rising, they start wearing masksand using social distancing again; and when they realize that fresh cases aredropping, they tend to drop their 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.

The rate of infection in a population is based on the"R0," or reproduction number. R0 represents the average number ofpeople who will contract the infection from a single infected person, in apopulation thats never been witness to the disease before. If R0 is 3, itsuggests that one case will create an average of three new cases. When thattransmission rate of infection 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.

IHME found the "effective R over 1 in Oklahoma. Inall other states the effective R was found to be less than 1.”

2.     CDC: Relies on positive testsresults. CDCs report these as confirmed cases. The positivity rate suggests howtough or easy it is to find a case, which is an indicator of both the spread ofCOVID-19 and how widespread testing is. If the rate of positive tests is 20%,one doesn’t have to look hard to find a case, compared to 1%, which means thatone has to do a lot of tests to get a positive one. The more COVID-19 spreads,the higher the positivity rate. A 60% positivity rate may suggest that testingis only 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 reports the daily positivity percentage (percentage of positive tests andtotal testing volume since March). While looking at testing, one wants to know howmany tests were done historically with the ability to compare and understand ifthe number has increased or declined or is stable and the percentage that ispositive. 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 oftenfluctuate, depending on where testing is done and when the labs report testresults. A sudden surge in testing numbers may point to a large number of testsdone in a group setting such as a nursing home or prison on a single day.Laboratories and hospitals report test results on weekdays, so the numbers candecline on weekends.

5.     A major goal during thecoronavirus epidemic has been to flatten the curve to maintain local hospitalcapacity. After expected COVID-19 surges, many hospitals limited surgeries andadmissions to preserve their resources, including hospital beds, ventilators,and healthcare personnel.

 [WebMD]

Infrastructure Capacity

1.     If hospital capacity reaches80%, we may have to stop admitting patients to prevent the hospital from beingoverwhelmed.

2.     In order to plan for surges andincrease capacity: It is required to know the number of people who testedpositive and were admitted to the hospital with symptoms of COVID-19.

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

4.      Pennsylvania: Reports thenumber of ventilators COVID-19 patients and non-COVID-19 patients use everyday.

5.     Illinois lists the recoveryrate: In Illinois, the recovery rate of 95% has been calculated as recoveredcases divided by recovered cases plus confirmed deaths. This indicates thequality of medical care and the severity of disease.

[WebMD]

Some Numbers 

1.     Cases will double after theaverage doubling time of the country at that time

2.     Casesexpected in the community:

                                                                              Getnumber of deaths occurring in a five-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 estimateof the total number of cases, confirmed and unconfirmed

3.     Lockdown effect: Reduction in cases after average incubation period (5 days)

4.     Lockdown effect in reduction in deaths: Reduction in number of deaths on day 14(average time to death of that country)

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

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

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

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

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

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

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

12.  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