World COVID Meter 4th September: Acute manageable immuno-thrombo-inflammatory viral disease with post viral phase, 213 Countries Affected

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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, 18M August 1, 19M August 6, 20M August 10, 21M August 16, 22M August 19, 23M August 21, 24M August 27, 25M August 30

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: 26,458,208

Deaths: 872,508

Recovered: 18,652,739

ACTIVE CASES 6,932,961

Currently Infected Patients 6,872,085 (99%) in Mild Condition

60,876 (1%) Serious or Critical

CLOSED CASES 19,525,247

Cases which had an outcome: 18,652,739 (96%) Recovered / Discharged

872,508 (4%) Deaths

India number 1 in new cases, Number 3 in total deaths and total cases

India-Brazil difference over 25000 per day, or one lac in 3-4 days

Total difference 113026; By September 10, India may cross Brazil; India, at this speed, may also cross USA

3rd September: New Cases 84156, New Deaths 1083, Total Cases 3933124, Total Deaths 68569

2nd September: New Cases 82860, New deaths 1026, Total cases 3848968 Total Deaths 67486

1st September: New cases 78169, New deaths 1025, Total cases 3766108, Total deaths 66460

31st August: New cases 68770, New Deaths 818, Total cases 3687939, Total deaths 65435

30th August: New cases 79457, New deaths 960, Total cases 3619169, Total deaths 64617

29th August: New Cases 78472 New deaths 944 Total cases 3539712 Total deaths 63657

28th August: New Cases 76665, New Deaths 1019, Total cases 3461240, Total deaths 62713

27th August: New Cases 76826, New Deaths 1065, Total cases 3384575, Total deaths 61694

26th August: New cases 75995, New deaths 1017, Total cases 3307749, Total deaths 60629

25th August: New cases 66873, New Deaths 1066, Total cases 3231754, Total deaths 59612

24th August: New cases 59696, New deaths 854, Total cases 3164881, Total deaths 58546

23rd August: New cases 61749, New deaths 846, Total cases 3105185, Total deaths 57692

22nd August: New cases 70068; new deaths 981; Total cases 3043436; Total Deaths 56846

21st August: New Cases 69039; new deaths 953, Total cases 2973368, total deaths 55928

20th August: Cases 68507, 981 deaths, 2904329 total cases, 54975 total deaths

19th August: Cases 69196, 980 deaths, 2835822 total cases, 53994 total deaths

18th August: cases 65022, 1089 deaths, 2766626 total cases, 53014 total deaths

17th August: 54288 cases, 880 deaths, 2701604 total cases, 51925 total deaths

16th August: 58108 cases, 961 deaths, 2647316 total cases, 51045 deaths

15th August: 63986 new cases, 950 deaths, 2589208 total cases, 50084 deaths

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]
  1. COVID Sutras:COVID-19 pandemic is 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.
  2. 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].
  3. Viral particles seen in tears, stool, kidneys, liver, pancreas, heart, semen, peritoneal fluid, CSF.
  4. Thrombosis: University of Pennsylvania has reported that clots are seen in patients even on blood thinners.
  5. Other human beta-coronaviruses have immunity lasting only for one year with no IMMUNITY PASSPORT.
  6. In absence of interventions, prolonged or intermittent social distancing (till 2022-24) is the key.
  7. 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.
  8. During peak, trace and treat, and after the peak, trace and treat the close contacts.
  9. Increased spread: close environment, crowded place with close physical contacts with no ventilation.
  10. 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.
  11. HCW: Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.
  12. Italy: mortality reduced when they were short of ventilators.
  13. Hospital at HOME: CHF, mild pneumonia, exacerbations of asthma and COPD, cellulitis, and urinary tract infections.
  14. Great Imitator (protean manifestation).
  15. IgM can be false positive in pregnancy, immunological diseases; Pooled tests (< 5, 20 Kerala, 64 Singapore RTPCR) when seroprevalence is < 2%.
  16. 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.
  17. 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.
  18. Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.

Formulas

  1. Deaths in symptomatic cases: Less than one percent (best of the care)

Therefore, Deaths X 100= expected number of symptomatic cases

  1. Cases after seven days: Cases today x 2 (based on doubling time 7 days, will change as per doubling time of the country)

  1. 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

  1. Lock down effect = Reduction in cases after average incubation period (5 days)
  1. Lock down effect in reduction in deaths: Reduction in number of deaths on day 14 (average time to death of that country)
  1. Requirement of ventilators on day 9: 1-3% of number of new cases detected
  1. Requirement of future oxygen on day seven: 10% of total cases detected today
  1. Number of people which can be managed at home care: 90% of number of cases today
  1. Requirement of ventilators: 1-3% of number of cases admitted 7-9 days back
  1. Requirement of oxygen beds today: 10% of total cases admitted seven days back
  1. Case fatality rate: Number of total deaths as on date/number of total RTPCR positive cases as on today
  1. Infection fatality rate: Number of total deaths as on date/number of total calculated cases as on today
  1. Number of reported deaths = Number of confirmed deaths x 2
  1. Number of unreported or untested cases = Number of reported cases x 10-30 (depending on the country, New York 10, Delhi 23.8, Pakistan 30)
  1. Number of asymptomatic cases: For 6 symptomatic cases, 200 asymptomatic cases
  1. Oxygen requirement on that day in the hospital at 6am: Number of cases detected to have hypoxia on six minutes walk test.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA