World COVID Meter 31st July: India Number 3, 213 Countries Affected

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

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

Coronavirus Cases: 17,464,995

Deaths: 676,409

Recovered:       10,932,912

ACTIVE CASES 5,855,674

Currently Infected Patients 5,789,284 (99%) in Mild Condition

66,390 (1%) Serious or Critical

CLOSED CASES 11,609,321

Cases which had an outcome: 10,932,912 (94%) Recovered/Discharged

676,409 (6%) Deaths

India races with Brazil

# Country,Other TotalCases NewCases TotalDeaths NewDeaths TotalRecovered ActiveCases Serious,Critical Tot Cases/1M pop Deaths/1M pop TotalTests Tests/1M pop Population
World 17,456,494 +280,337 675,762 +6,221 10,927,804 5,852,928 66,386 2,240 86.7
1 USA 4,634,985 +68,569 155,285 +1,465 2,284,965 2,194,735 18,783 13,996 469 57,521,144 173,695 331,161,077
2 Brazil 2,613,789 +58,271 91,377 +1,189 1,824,095 698,317 8,318 12,290 430 12,601,096 59,249 212,681,838
3 India 1,639,350 +54,966 35,786 +783 1,059,093 544,471 8,944 1,187 26 18,190,382 13,171 1,381,085,714

 

Doubling Time

Date Daily new cases New Deaths Total cases Total Deaths
30th July 54966 783 1639350 35786
29th July 52249 779 1584384 35003
28th July 49632 776 1532135 34224
27th July 49632 776 1532135 34224
26th July 50525 716 1436019 32812
25th July 48472 690 1385494 32096
24th July 48892 761 1337022 31406
23rd July 48446 755 1288130 30645
22nd July 45599 1120 1239684 29890
21st July 39168 671 1194085 28770
20th July 36810 596 1154917 28099
19th July 40243 675 1118107 27503
18th July 37407 543 1077864 26828
17th July 34820 676 1040457 26285
16th July 35468 680 1005637 25609
15th July 32682 614 970169 24929
14th July 29842 588 937487 24315
13th July 28179 540 907645 23727
12th July 29108 500 879446 23187
11th July 27755 543 850358 22687
10th July 27761 521 822603 22144
9th July 25790 479 794842 21623

India predictions

  1. Death rate 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 and 20 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 days back.
  6. Undocumented cases for each documented case – 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

  1. 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]
  2. 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 over eleven virus sequences floating; has affected up to 22.8% of Delhi population, 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), 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.
  3. 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].
  4. Viral particles seen in tears, stool, kidneys, liver, pancreas, heart, semen, peritoneal fluid, CSF.
  5. Thrombosis: University of Pennsylvania reports that clots are seen in patients even on blood thinners.
  6. Other human beta-coronaviruses have immunity lasting only for one year with no IMMUNITY PASSPORT.
  7. In absence of interventions, prolonged or intermittent social distancing (till 2022-24) is the key.
  8. Low levels of cross immunity from 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.
  9. During peak, trace and treat, and after the peak, trace and treat the close contacts.
  10. Increased spread: close environment, crowded place with close physical contacts with no ventilation.
  11. 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.
  12. HCW: Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.
  13. Italy: mortality reduced when they were short of ventilators.
  14. Hospital at HOME: CHF, mild pneumonia, exacerbations of asthma and COPD, cellulitis, and urinary tract infections.
  15. Great Imitator (protean manifestation).
  16. IgM can be false positive in pregnancy, immunological diseases; Pooled tests (< 5, 20 Kerala, 64 Singapore RTPCR) when seroprevalence is < 2%.
  17. Early treatment, day 3-5, to reduce the viral load and prevent cytokine storm using hydroxychloroquine with azithromycin or ivermectin with doxycycline with IV remdesivir and IV single dose tocilizumab (IL-6 receptor inhibitor) if very high D-dimer and IL-6; convalescent plasma therapy (given early; donor 14 days symptoms free, between day 28-40, single donation can help 4 patients); Lopinavir-ritonavir and Favipiravir if very low CD 4 counts.
  18. 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.
  19. Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.
  20. 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); Requirement 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;  Requirement 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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