World COVID Meter 10th June – 213 Countries affected: Wear mask at home

Cases: 1M April 2, 2M April 15, 3M April 27, 4M May 8, 5M May 20, 6M May 30, 7M June 7

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

Doubling time India 15 days, USA 33 days, Brazil 13 days, Russia 18 days, Spain 47 days, UK 35 days, Italy 55 days, France 49 days, Turkey 37 days

Likely minimum deaths (408594  + 53798 x 15 = 8070) = 416663   

Coronavirus Cases: 7,312,198

Deaths: 413,003

Recovered: 3,599,115

ACTIVE CASES: 3,300,080

Currently Infected Patients 3,246,058 (98%) in Mild Condition

54,022 (2%) Serious or Critical

CLOSED CASES: 4,012,118

Cases which had an outcome: 3,599,115 (90%) Recovered/Discharged

413,003 (10%) Deaths

938.1 cases per million population (India 200)

53 deaths per million population (India 6)

India Doubling Time: 15 Days.

Serious 8944, Likely more deaths 1341

# Country,Other TotalCases NewCases TotalDeaths NewDeaths TotalRecovered ActiveCases Serious,Critical Tot Cases/1M pop Deaths/1M pop TotalTests Tests/1M pop Population
1 India 276,146 +10,218 7,750 +277 134,670 133,726 8,944 200 6 4,916,116 3,564 1,379,196,659
Total: 7,312,198 +121,751 413,003 +4,763 3,599,263 3,299,932 54,022 938.1 53.0

28 Days

Date Daily new cases New Deaths Total cases Total Deaths
 
9th June 10218 277 276146 7750 (2.8%)
8th June 8442 266 265928 7473
7th June 10864 261 257486 7207
6th June 10438 297 246622 6947
5th June 9471 286 236184 6649
4th June 9889 275 226713 275
3rd June 9633 259 216824 6088
2nd June 8821 221 207191 5829
1st June 7761 200 198370 5608
31st May 8782 223 190609 5408
30th May 8336 205 181827 5185
29th May 8105 269 173491 4980
28th May 7300 177 165386 4711
27th May 7293 190 158086 4534
26th May 5843 172 150793 4344
25th May 6414 148 144950 4172
24th May 7113 156 138536 4024
23rd May 6629 142 131423 3868
22nd May 6568 142 124794 3726
21st May 6198 150 118226 3584
20th May 5553 132 112028 3434
19th May 6147 146 106475 3302
18th May 4630 131 100328 3156
17th May 5050 154 95698 3025
16th May 4864 118 90648 2781
15th May 3787 104 85784 2753
14th May 3942 98 81997 2649
13th May 3763 136 78055 2551

 

India in top 6, Top 3 in new cases per day, Will be in top 4 in two days   

# Country,Other TotalCases NewCases TotalDeaths NewDeaths TotalRecovered ActiveCases Serious,Critical Tot Cases/1M pop Deaths/1M pop TotalTests Tests/1M pop Population
World 7,312,198 +121,751 413,003 +4,763 3,599,263 3,299,932 54,022 938 53.0
1 USA 2,045,549 +19,056 114,148 +1,093 788,862 1,142,539 16,952 6,182 345 22,140,676 66,912 330,891,117
2 Brazil 742,084 +31,197 38,497 +1,185 325,602 377,985 8,318 3,493 181 999,836 4,706 212,471,616
3 Russia 485,253 +8,595 6,142 +171 242,397 236,714 2,300 3,325 42 13,254,678 90,828 145,931,041
4 UK 289,140 +1,741 40,883 +286 N/A N/A 516 4,260 602 5,870,506 86,502 67,865,632
5 Spain 289,046 +249 27,136 N/A N/A 617 6,182 580 4,465,338 95,508 46,753,788
6 India 276,146 +10,218 7,750 +277 134,670 133,726 8,944 200 6 4,916,116 3,564 1,379,196,659

India predictions

  1. >90% of people are symptomatic within 2 weeks of infection.
  2. Death rate is deaths today vs. number of cases today.
  3. Corrected death rate is deaths today vs. number of cases 14 days back.
  4. For one symptomatic test positive case, there are 10-30 asymptomatic cases.
  5. Estimated number of deaths = Reported deaths x 2.
  6. Number of deaths today should be 15% of the serious patients present 14 days back.
  7. Undocumented cases for each documented case – Iceland: 1: 2; Germany: 1: 5; New York City grocery store shoppers: 1: 10;California 1.5%.
  8. Amongst active cases, 2.37% are serious, 1.82% need oxygen, and 0.41% need ventilator support.

Extra Reading Background Material

  1. China: Captured tiny droplets of viral genetic markers in 2 hospitals in Wuhan floating for > 2 hours. Infectivity? [Journal Nature]
  2. India: In states with average population density of 1185/sq km, the average number of cases were 2048. On the contrary, in states with population density of 909/sq 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]
  3. Revised COVID Sutras: It’s a COVID-19 pandemic due to SARS 2 Beta-coronaviruses (different from SARS 1 where spread was only in serious cases); with three virus sequences floating (one similar to Wuhan, second similar to Iran and the third strain similar to USA – UK); has affected up to 10%  (5.7%  S Korea) of the population; Causes Mild or Asymptomatic 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), 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 of copies of itself, which are then breathed or coughed out and infect others.
  4. 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].
  5. Viral particles seen in tears, stool, kidneys, liver, pancreas, heart, semen, peritoneal fluid, CSF.
  6. Thrombosis: University of Pennsylvania reports that clots are seen in patients even on blood thinners.
  7. Other human beta-coronaviruses have immunity lasting only for one year with no IMMUNITY PASSPORT.
  8. In absence of interventions, prolonged or intermittent social distancing (till 2022-24) is the key.
  9. Low levels of cross immunity from the other beta-coronaviruses against SARS-CoV-2 could make SARS-CoV-2 appear to fade away, only to return after a few years. Surveillance till 2024.
  10. During peak, trace and treat, and after the peak, trace and treat the close contacts.
  11. Increased spread: close environment, crowded place with close physical contacts with no ventilation.
  12. 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
  13. HCW: Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.
  14. Italy: mortality reduced when they were short of ventilators.
  15. Hospital at HOME: CHF, mild pneumonia, exacerbations of asthma and COPD, cellulitis, and urinary tract infections.
  16. Great Imitator (protean manifestation).
  17. IgM can be false positive in pregnancy, immunological diseases; Pooled tests (< 5) when seroprevalence is < 2%.
  18. Early treatment to reduce the viral load and prevent cytokine storm using off label use of drugs like hydroxychloroquine with azithromycin; ivermectin, remdesivir; Tocilizumab interleukin (IL)-6 receptor inhibitor; convalescent plasma therapy (given early; bridge compassionate therapy, donor 14 days symptoms free, single donation can help 4 patients), Lopinavir-ritonavir and Favipiravir.
  19. Hypoxia: Low flow oxygen < 6l/mt, titrated to high flow oxygen using non rebreathing mask, Venturi mask, HFNC and helmet CPAP, NIV in supine or prone position.
  20. Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.
  21. Formulas: Deaths in symptomatic cases 1%; Deaths X 100= expected number of symptomatic cases; Cases after seven days: Cases today x 2 (doubling time 7 days); Cases expected in the community: Number of deaths occurring in a five-day period and estimate the number of infections required to generate these deaths based on a 6.91% 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: On day 14 (time to death); Requirements of ventilators on day 9: 3% of number of new cases detected;  Requirement of future oxygen on day seven: 15% of total cases detected today;  Number of people which can be managed at home care: 80% of number of cases today;  Requirements of ventilators: 3% of Number of cases today;  Requirement of oxygen beds today: 15% of total cases today.

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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