Coronavirus Cases: 180,350,950           

Deaths: 3,907,028

Recovered: 165,074,339                   

ACTIVE CASES: 11,369,583           

Serious/Critical Cases: 81,566           

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

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

India Scenario

23^rd June: New Cases 54319, New Deaths 978, Total Cases 30082169, Total Deaths 392014, Active Cases 633546

22^nd June: New Cases 54393, New Deaths 1129, Total Cases 30027850, Total Deaths 390691, Active Cases 649848

21^st June: New Cases 39096, New Deaths 846, Total Cases 29973457, Total Deaths 389268, Active Cases 670998

20^th June: New Cases 53009, New Deaths 1113, Total Cases 29934361, Total Deaths 388164, Active Cases 709668

19^th June: New Cases 58588, New Deaths 1239, Total Cases 29881352, Total Deaths 386740, Active Cases 736165

18^th June: New Cases 60800, New Deaths 1269, Total Cases 29822764, Total Deaths 385167, Active Cases 766718

17^th June: New Cases 62409, New Deaths 1310, Total Cases 29761964, Total Deaths 383521, Active Cases 805422   

16^th June: New Cases 67294, New Deaths 1411, Total Cases 29699555, Total Deaths 381931, Active Cases 833080

15^th June: New Cases 62226, New Deaths 1470, Total Cases 29632261, Total Deaths 379601     (including backlog), Active Cases 872026

14^th June: New Cases 62597, New Deaths 1452, Total Cases 29570035, Total Deaths 377061     (including backlog), Active Cases 920194

13^th June: New Cases 68400, New Deaths 1761, Total Cases 29507438, Total Deaths 374287 (including backlog), Active Cases 984174

12^th June: New Cases 81005, New Deaths 1830, Total Cases 29439038, Total Deaths 372526 (including backlog), Active Cases 1032745 

11^th June: New Cases 84695, New Deaths 4000, Total Cases 29358033, Total Deaths 367097, Active Cases 1089248

10^th June: New Cases 91266, New Deaths 3402, Total Cases 29273338, Total Deaths 363097, Active Cases 1131347

9^th June: New Cases 93896, New Deaths 6138    , Total Cases 29182072, Total Deaths 359695, Active Cases 1177152

8^th June: New Cases 91227, New Deaths 2213    , Total Cases 29088176, Total Deaths 353557, Active Cases 1238421

7^th June: New Cases 87345, New Deaths 2115    , Total Cases 28996949, Total Deaths 351344, Active Cases 1308806

6^th June: New Cases 101232, New Deaths 2445, Total Cases 28909604, Total Deaths 349229, Active Cases 1409648   

5^th June: New Cases 114537, New Deaths 2683, Total Cases 28808372, Total Deaths 346784, Active Cases 1484977

4^th June: New Cases 121476, New Deaths 3382, Total Cases 28693835, Total Deaths 344101, Active Cases 1562604

3^rd June: New Cases 131371, New Deaths 2706, Total Cases 28572359, Total Deaths 340719, Active Cases 1642832

2^nd June: New Cases 134105, New Deaths 2899, Total Cases 28440988, Total Deaths 338013    , Active Cases 1720078

1^st June: New Cases 133228, New Deaths 3205, Total Cases 28306883, Total Deaths 335114, Active Cases 1800777

 (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, 166M May 23, 167M May 25, 168M May 27, 169M May 28, 170M May 31

• 171M June 2, 172M June 4, 173M June 7, 174M June 9, 175M June 12, 176M June 15, 177M June 18, 178M June 20, 179M June 23 

COVID-19 Variants

SARS-CoV-2 Variants of Concern

(Source: WHO)

* A new “Delta plus” variant (B.1.617.2.1 or AY.1) has been formed due to a new mutation K417N in the Delta variant. The Union Health Ministry has said that the Delta Plus variant is now a Variant of Concern in India.

SARS-CoV-2 Variants of Interest

(Source: WHO)

Hybrid of Indian and UK COVID-19 variants: Vietnam has uncovered a new Covid-19 variant combining characteristics of the two existing variants first found in India and the UK, which can spread quickly by air. The concentration of virus in the throat fluid increases rapidly and spreads very strongly to the surrounding environment. The WHO has said that there is no new hybrid strain. The strain detected in Vietnam is part of delta strain first detected in India.

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.