CMAAO: In susceptible high-risk (pro-inflammatory and/or pro-coagulative) individuals, reactogenic vaccines can trigger transient thrombo-inflammation lasting first few (up to four) days.

COVID Vaccine: non-replicative, non-repetitive dose, spike gene mRNA/spike gene DNA to mRNA/whole killed virus, reactogenic vaccine

Coronavirus Cases: 167,516,375

Deaths: 3,478,219

Recovered: 148,585,994

ACTIVE CASES: 15,452,162

Serious/Critical Cases: 96,982

(Source: https://www.worldometers.info/coronavirus/; May 23, 2021)

 (Source: https://www.worldometers.info/coronavirus/; May 23, 2021) 

India

23^rd May: New Cases 222835, New Deaths 4455, Total Cases 26751681, Total Deaths 303751, Active Cases 2727011

22^nd May: New Cases 243777, New Deaths 3788, Total Cases 26528846, Total Deaths 299296, Active Cases 2811027

21^st May: New Cases 254395, New Deaths 4143, Total Cases 26285069, Total Deaths 295508, Active Cases 2930544

20^th May: New Cases 259269, New Deaths 4209, Total Cases 26030674, Total Deaths 291365, Active Cases 3033408

19^th May: New Cases 276261, New Deaths 3880, Total Cases 25771405, Total Deaths 287156, Active Cases 3135566

18^th May: New Cases 267174, New Deaths 4525, Total Cases 25495144, Total Deaths 283276, Active Cases 3232165

17^th May: New Cases 263045, New Deaths 4340, Total Cases 25227970, Total Deaths 278751, Active Cases 3359216

16^th May: New Cases 281860, New Deaths 4092, Total Cases 24964925, Total Deaths 274411, Active Cases 3522905 

15^th May: New Cases 310822, New Deaths 4090, Total Cases 24683065, Total Deaths 270319, Active Cases 3623708 

14^th May: New Cases 326123, New Deaths 3879, Total Cases 24372243, Total Deaths 266229, Active Cases 3679691 

13^th May: New Cases 343288, New Deaths 3999, Total Cases 24046120, Total Deaths 262350, Active Cases 3710403

12^th May: New Cases 362406, New Deaths 4126, Total Cases 23702832, Total Deaths 258351, Active Cases 3716045

11^th May: New Cases 348499, New Deaths 4200, Total Cases 23340426, Total Deaths 254225, Active Cases 3709551 

10^th May: New Cases 329517, New Deaths 3879, Total Cases 22991927, Total Deaths 250025, Active Cases 3720695

9^th May: New Cases 366499, New Deaths 3748, Total Cases 22662410, Total Deaths 246146, Active Cases 3750998

8^th May: New Cases 409300, New Deaths 4133, Total Cases 22295911, Total Deaths 242398, Active Cases 3742015

7^th May: New Cases 401326, New Deaths 4194, Total Cases 21886611, Total Deaths 238265, Active Cases 3731261

6^th May: New Cases 414433, New Deaths 3920, Total Cases 21485285, Total Deaths 234071, Active Cases 3653804

5^th May: New Cases 412618, New Deaths 3982, Total Cases 21070852, Total Deaths 230151, Active Cases 3571625

4^th May: New Cases 382691, New Deaths 3786, Total Cases 20658234, Total Deaths 226169, Active Cases 3493665

3^rd May: New Cases 355828, New Deaths 3438, Total Cases 20275543, Total Deaths 222383, Active Cases 3452457

2^nd May: New Cases 370059, New Deaths 3422, Total Cases 19919715, Total Deaths 218945, Active Cases 3419032

1^st May: New Cases 392562, New Deaths 3688, Total Cases 19549656, Total Deaths 215523, Active Cases 3352361

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

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 29
• 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, 25M August 30, 26M September 3, 27M September 7, 28M September 10, 29M September 14, 30M September 18
• 31M September 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, 55M November 17, 56M November 19, 57M November 20, 58M November 22, 59M November 24, 60M November 25 
• 61M November 27, 62M November 29, 63M December 1, 64M December 2, 65M December 4, 66M December 6, 67M December 7, 68M December 9, 69M December 10, 70M December 12 
• 71M December 13, 72M December 14, 73M December 15, 74M December 17, 75M December 19, 76M December 20, 77M December 22, 78M December 23, 79M December 26, 80M December 27 
• 81M December 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 
• 91M January 12, 92M January 14, 93M January 15, 94M January 17, 95M January 18, 96M January 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, 105M February 6, 106M February 8, 107M February 11, 108M February 13, 109M February 16, 110M February 18 
• 111M February 21, 112M February 24, 113M February 28, 114M March 1, 115M March 4, 116M March 6, 117M March 9, 118M March 11, 119M March 13, 120M March16 
• 121M March 18, 122M March 19, 123M March 22, 124M March 24, 125M March 26, 126M March 27, 127M March 30, 128M March 31, 129M April 2, 130M April 3 
• 131M April 5, 132M April 7, 133M April 8, 134M April 9, 135M April 11, 136M April 12, 137M April 14, 138M April 15, 139M April 16, 140M April 17
• 141M April 19, 142M April 20, 143M April 21, 144M April 22, 145M April 24, 146M April 25, 147M April 26, 148M April 28, 149M April 29, 150M April 30
• 151M May 1, 152M May 3, 153M May 4, 154M May 5, 155M May 6, 156M May 7, 157M May 9, 158M May 10, 159M May 11, 160M May 13 
• 161M May 14, 162M May 16, 163M May 17, 164 M May 19, 165M May 21, 166 M May 23

COVID-19 Variants

Variants - B 1.1.7, B.1.351, P1, B.1.617 

B.1.1.7 

• Also known as 501Y.V1
• First detected in the United Kingdom (UK)
• Key mutations in the spike protein: N501Y (RBD), 69/70 deletion, 144Y deletion, P681H (S1/S2 furin cleavage site) 
• Increased transmissibility (vs ancestral) (~50-70%)
• Increased severity/fatality (>30%)
• Minimal immune evasion
• Minimal impact on neutralization by convalescent and post-vaccination sera

B.1.351

• Also known as 501Y.V2
• First identified in South Africa
• Key mutations in spike protein: N501Y, K417N, E484K, 241/242/243 deletion
• Transmissibility (vs ancestral) minimal
• No evidence of increase in lethality
• Immune evasion 

• Significant decrease in susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment
• Reduced neutralization by convalescent and post-vaccination sera

P.1

• Also known as 501Y.V3
• First identified in Brazil/Japan 
• Key mutations in spike protein (RBD): N501Y, K417T, E484K
• Increased transmissibility (vs ancestral) 
• No evidence of increased severity/lethality
• Immune evasion

• Significant decrease in susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment
• Reduced neutralization by convalescent and post-vaccination sera

B.1.617

• Also known as 21A/S
• 3 sub-lineages: B.1.617.1, B.1.617.2 and B.1.617.3
• First identified in India “double mutant”
• Key mutations in spike protein: E484Q, L452R
• Increased transmissibility (vs ancestral) 
• No evidence of increased lethality
• Immune evasion

• Potential reduction in neutralization by some EUA monoclonal antibody treatments4
• Slightly reduced neutralization by post-vaccination sera

B.1.427 and B.1.429 

These two variants were first identified in California in February 2021.

Some consequences of emerging variants

• Potential for quicker spread (increased transmissibility) 
• Potential to cause milder or more severe disease in people
• Potential to evade detection by viral diagnostic tests: 1.1.7 has S gene target failure
• Diminished susceptibility to therapeutic agents like monoclonal antibodies
• Potential to evade natural or vaccine-induced immunity

Variants of concern might require one or more appropriate public health actions, such as notification to WHO under the International Health Regulations, reporting to CDC, local or regional efforts to control spread, increased testing, or research to determine the effectiveness of vaccines and treatments against the variant. Based on the characteristics of the variant, additional considerations may include the development of new diagnostics or the modification of vaccines or treatments (CDC).

India predictions: Formulas for better understanding of data

1. Death rate is number of deaths today vs number of cases today 
2. Corrected death rate is number of deaths today vs number of cases 14 days back. 
3. Estimated number of deaths = Reported deaths x 2
4. Number of expected deaths today is 15% of the number of serious patients 14 days back.
5. For one symptomatic positive case, there are 10-30 asymptomatic cases and 20 untested cases.
6. 85-90% positive cases are asymptomatic or have mild infection; 10-15% of positive cases may develop severe infection (require oxygen, steroids, remdesivir); about 5% cases become critical (require ventilator and stronger medicines).

COVID Sutra

COVID-19 pandemic is due to SARS 2 Beta-coronavirus (different from SARS 1 where spread was only in serious cases); 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), Origin Possibly from Bats (Mammal); spreads through the air (by inhalation of air carrying very small fine droplets and aerosol particles, human to human transmission via large and small droplets or touching inanimate surfaces contaminated with virus . Enters through MM of eyes, nose or mouth and the spike protein gets attached to the ACE2 receptors, which are found in organs throughout the body (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.

10 Sutras to remember

• Universal masking (correct, consistent and 3-layered) is THE prevention.
• RTPCR Ct is THE gold standard test for diagnosis.  
• Zinc is THE mineral; D is THE vitamin. 
• Day 5 is THE day in COVID phase for mortality prevention.  
• Day 90 is THE day after which the word COVID ends. 
• Home isolation is THE modality of treatment. (The policy may vary from country to country.) 
• 12 years is THE age when the mortality starts. (Children 12 years or older should wear masks as recommended for adults – WHO UNICEF guidelines)
• CRP is THE lab test for seriousness.
• Loss of smell and taste are THE symptoms equal to RTPCR test. 
• 15 minutes is THE contact time to get the infection.

Some more numbers

• If hospital capacity reaches 80%, we may have to stop admitting patients to prevent the hospital from being overwhelmed.
• In order to plan for surges and increase capacity: It is required to know the number of people who tested positive and were admitted to the hospital with symptoms of COVID-19.
• Cases will double after the average doubling time of the country at that time
• 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
• Lock down effect: Reduction in cases after average incubation period (5 days)
• Lock down effect in reduction in deaths: Reduction in number of deaths on day 14 (average time to death of that country)
• Requirement of ventilators on day 9: 1-3% of number of new cases detected
• Requirement of future oxygen on day 7: 10% of total cases detected today
• Number of people which can be managed at home care: 90% of number of cases today
• Requirement of ventilators: 1-3% of number of cases admitted 7-9 days back
• Requirement of oxygen beds today: 10% of total cases admitted seven days back
• Oxygen requirement on that day in the hospital at 6am: Number of cases detected to have hypoxia on six minutes walk test.